Department of Urology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain.
Division of Urology, Departments of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada.
Minerva Urol Nefrol. 2020 Dec;72(6):650-662. doi: 10.23736/S0393-2249.20.04018-7.
Radical cystectomy (RC) is the current mainstay for muscle-invasive bladder cancer (MIBC). Concerns regarding morbidity, mortality and quality of life have favored the introduction of bladder sparing strategies. Trimodal therapy, combining transurethral resection, chemotherapy and radiotherapy is the current standard of care for bladder preservation strategies in selected patients with MIBC.
A comprehensive search of the Medline and Embase databases was performed. A total of 19 studies were included in a systematic review of bladder sparing strategies in MIBC management was carried out following the preferred reporting items for systematic reviews and meta-analysis (PRISMA).
The overall median complete response rate after trimodal therapy (TMT) was 77% (55-93). Salvage cystectomy rate with TMT was 17% on average (8-30). For TMT, the 5-year cancer-specific survival and overall survival rates range from 42-82% and 32-74%, respectively. Currently data supporting neoadjuvant or adjuvant chemotherapy in bladder sparing approaches are emerging, but robust definitive conclusions are still lacking. Gastrointestinal toxicity rates are low around 4% (0.5-16), whereas genitourinary toxicity rates reached 8% (1-24). Quality of life outcomes are still underreported.
Published data and clinical experience strongly support trimodal therapy as an acceptable bladder sparing strategy in terms of oncological outcomes and quality of life in selected patients with MIBC. A strong need exists for specialized centers, to increase awareness among urologists, to discuss these options with patients and to stress the increased participation of patients and their families in treatment path decision-making.
根治性膀胱切除术（RC）是肌层浸润性膀胱癌（MIBC）的当前主要治疗方法。对发病率、死亡率和生活质量的担忧促使人们引入了保留膀胱的策略。多模式治疗，结合经尿道膀胱肿瘤切除术、化疗和放疗，是目前 MIBC 患者保留膀胱策略的标准治疗方法。
对 Medline 和 Embase 数据库进行了全面检索。对 MIBC 管理中保留膀胱策略的系统评价进行了系统评价和荟萃分析（PRISMA）的综合检索。
经多模式治疗（TMT）后的总体完全缓解率中位数为 77%（55-93）。平均保膀胱切除术率为 17%（8-30）。对于 TMT，5 年癌症特异性生存率和总生存率分别为 42-82%和 32-74%。目前，支持新辅助或辅助化疗在保留膀胱方法中的数据正在出现，但仍缺乏确凿的结论。胃肠道毒性率约为 4%（0.5-16），而泌尿生殖毒性率达到 8%（1-24）。生活质量结果仍报告不足。
发表的数据和临床经验强烈支持多模式治疗作为一种可接受的保留膀胱策略，在选择的 MIBC 患者中具有良好的肿瘤学结果和生活质量。强烈需要有专门的中心，提高泌尿科医生的认识，与患者讨论这些选择，并强调患者及其家属在治疗路径决策中更多地参与。
