University of North Carolina at Chapel Hill School of Medicine; Chapel Hill, NC, USA.
2 Department of Urology, University of North Carolina at Chapel Hill; Chapel Hill, NC, USA.
Int Braz J Urol. 2020 Mar-Apr;46(2):169-184. doi: 10.1590/S1677-5538.IBJU.2020.99.01.
Standard management of muscle-invasive bladder cancer involves radical cystectomy with pelvic lymph node dissection. However, patients may be ineligible for surgery or may wish to avoid the morbidity of cystectomy due to quality of life concerns. Bladder preservation therapies have emerged as alternatives treatment options that can provide comparable oncologic outcomes while maintaining patients' quality of life.
To review bladder preservation therapies, patient selection criteria, and functional and oncologic outcomes for BPT in muscle-invasive bladder cancer.
We conducted a comprehensive literature review of bladder preservation therapies in Pubmed and Embase.
The ideal patient for BPT has low-volume T2 disease, absence of CIS, absence of hydronephrosis, and a maximal TURBT with regular surveillance. Technological advancements involving cancer staging, TURBT technique, and chemotherapy and radiation therapy regimens have improved BPT outcomes, with oncologic outcomes now comparable to those of radical cystectomy. Advancements in BPT also includes a heightened focus on improving quality of life for patients undergoing bladder preservation. Preservation strategies with most evidence for use include trimodality therapy and partial cystectomy with pelvic lymph node dissection.
This review highlights the breadth of strategies that aim to preserve a patient's bladder while still optimizing local tumor control and overall survival. Future areas for innovation include the use of predictive biomarkers and implementation of immunotherapy, moving the field towards patient-tailored care.
肌层浸润性膀胱癌的标准治疗方法包括根治性膀胱切除术和盆腔淋巴结清扫术。然而，部分患者可能因身体状况无法接受手术，或出于生活质量方面的考虑而希望避免膀胱切除术带来的发病率。膀胱保留疗法作为替代治疗方案已经出现，在保留患者生活质量的同时，也能提供相当的肿瘤学结果。
综述肌层浸润性膀胱癌的膀胱保留疗法、患者选择标准，以及保膀胱治疗的功能和肿瘤学结果。
我们在 Pubmed 和 Embase 上进行了膀胱保留疗法的全面文献综述。
最适合接受 BPT 的患者是肿瘤体积较小的 T2 期疾病、无 CIS、无肾盂积水，且最大 TURBT 后定期进行监测。涉及癌症分期、TURBT 技术、化疗和放疗方案的技术进步提高了 BPT 的结果，肿瘤学结果现在与根治性膀胱切除术相当。BPT 的进展还包括更加关注提高接受膀胱保留治疗的患者的生活质量。目前最有证据支持使用的保留策略包括三联疗法和部分膀胱切除术联合盆腔淋巴结清扫术。
本文综述强调了多种策略的广度，这些策略旨在在保留患者膀胱的同时，仍然优化局部肿瘤控制和总体生存。未来的创新领域包括预测性生物标志物的使用和免疫疗法的实施，使该领域朝着个体化治疗方向发展。
