Wit Maike de, Retz Margitta M, Rödel Claus, Gschwend Jürgen E
Dtsch Arztebl Int. 2020 Apr 15;118(Forthcoming):169-76. doi: 10.3238/arztebl.m2021.0013.
In Germany, bladder carcinoma accounts for 3-4 % of all malignant tumors. New study findings in the fields of endoscopy, surgery, and systemic therapy have led to multimodal treatment approaches for bladder cancer that can prolong overall survival and improve the affected patients' quality of life.
This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to the German Clinical Practice Guideline on the Early Detection, Diagnosis, Treatment, and Continuing Care of Bladder Carcinoma, along with data available on the websites of the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA). The bladder carcinoma guideline of the Onkopedia guidelines program was used as well.
75% of all urothelial carcinomas are diagnosed in the non-muscle-invasive stage. These carcinomas should be resected via the endoscopic transurethral approach whenever possible. Next, depending on the patient's risk profile, intravesical therapy may be needed. Patients with carcinoma in the muscle-invasive stage should be given multimodal treatment, including radical cystectomy with urinary diversion and perioperative systemic therapy; alternatively, bladder-preserving chemoradiotherapy can be offered in selected cases. For patients with metastatic bladder carcinoma, immunotherapy with checkpoint inhibitors has become well established for first- and second-line therapy alongside classic cytostatic treatment and has been shown to prolong patients' lives significantly. The administration of checkpoint inhibitors can prolong the overall survival of patients with metastases to 15-17 months.
The treatment of bladder carcinoma in all stages calls for interdisciplinary collaboration to ensure the provision of effective, individual multimodal treatment.
在德国，膀胱癌占所有恶性肿瘤的3%-4%。内镜检查、手术及全身治疗领域的新研究成果已催生出针对膀胱癌的多模式治疗方法，这些方法可延长总生存期并改善患者生活质量。
本综述基于通过在PubMed中进行选择性检索获取的相关出版物，特别关注德国关于膀胱癌早期检测、诊断、治疗及持续护理的临床实践指南，以及美国食品药品监督管理局（FDA）和欧洲药品管理局（EMA）网站上的可用数据。同时也使用了Onkopedia指南计划的膀胱癌指南。
所有尿路上皮癌中有75%在非肌层浸润期被诊断出来。这些癌症应尽可能通过内镜经尿道途径切除。接下来，根据患者的风险状况，可能需要进行膀胱内治疗。肌层浸润期癌症患者应接受多模式治疗，包括根治性膀胱切除术加尿流改道及围手术期全身治疗；或者，在特定情况下可提供保膀胱放化疗。对于转移性膀胱癌患者，免疫检查点抑制剂疗法已成为一线和二线治疗的常用方法，与传统的细胞毒性治疗一起使用，并已证明可显著延长患者寿命。使用检查点抑制剂可将转移患者的总生存期延长至15-17个月。
膀胱癌各阶段的治疗都需要跨学科合作，以确保提供有效的个体化多模式治疗。
