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非肌肉浸润性膀胱癌的复发机制——临床视角。

Recurrence mechanisms of non-muscle-invasive bladder cancer - a clinical perspective.

机构信息

S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.

European Association of Urology-Young Academic Urologists (EAU-YAU) Urothelial Cancer Working Group, Amsterdam, Netherlands.

出版信息

Nat Rev Urol. 2022 May;19(5):280-294. doi: 10.1038/s41585-022-00578-1. Epub 2022 Mar 31.


DOI:10.1038/s41585-022-00578-1
PMID:35361927
Abstract

Non-muscle-invasive bladder cancer (NMIBC) is an early-stage cancer without invasion into the detrusor muscle layer. Transurethral resection of bladder tumour (TURBT) is a diagnostic and potentially curative procedure for NMIBC, but has some limitations, including difficulties in ascertaining complete tumour removal upon piecemeal resection and the possibility of tumour re-implantation after the procedure. The oncological control of NMIBC is far from satisfactory, with a 1-year recurrence rate of 15-61%, and a 5-year recurrence rate of 31-78%. Various recurrence mechanisms have been described for NMIBC, such as undetected tumours upon cystoscopy, incomplete resection during TURBT, tumour re-implantation after TURBT, drop metastasis from upper tract urothelial carcinoma and field change cancerization. Understanding the recurrence mechanisms from a clinical perspective has strong implications for the optimization of NMIBC oncological outcomes, as a cure for patients with NMIBC can only be achieved by tackling all possible recurrence mechanisms in a comprehensive manner.

摘要

非肌层浸润性膀胱癌(NMIBC)是一种早期癌症,未侵犯逼尿肌层。经尿道膀胱肿瘤切除术(TURBT)是 NMIBC 的一种诊断和潜在的治疗方法,但存在一些局限性,包括在分片切除时难以确定肿瘤是否完全切除,以及术后肿瘤可能再植入的可能性。NMIBC 的肿瘤控制远不理想,1 年复发率为 15-61%,5 年复发率为 31-78%。已经描述了 NMIBC 的各种复发机制,例如膀胱镜检查时未检测到肿瘤、TURBT 时不完全切除、TURBT 后肿瘤再植入、上尿路尿路上皮癌的脱落转移和野变化癌变。从临床角度理解复发机制对优化 NMIBC 的肿瘤学结果具有重要意义,因为只有通过全面解决所有可能的复发机制,才能治愈 NMIBC 患者。

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本文引用的文献

[1]
In vitro assessment of intra-operative and post-operative environment in reducing bladder cancer recurrence.

Sci Rep. 2022-1-7

[2]
Superpulse thulium fiber laser lithotripsy: an in vitro comparison of 200 μm and 150 μm laser fibers.

World J Urol. 2021-12

[3]
Systemic therapies for metastatic hormone-sensitive prostate cancer: network meta-analysis.

BJU Int. 2022-4

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Non-muscle-invasive bladder cancer: An overview of potential new treatment options.

Urol Oncol. 2021-10

[5]
The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study.

BJU Int. 2021-10

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An integrated multi-omics analysis identifies prognostic molecular subtypes of non-muscle-invasive bladder cancer.

Nat Commun. 2021-4-16

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Comparing an Imaging-guided Pathway with the Standard Pathway for Staging Muscle-invasive Bladder Cancer: Preliminary Data from the BladderPath Study.

Eur Urol. 2021-7

[8]
Attention to detail and a permissive set-up: crucial for an effective TURBT.

Nat Rev Urol. 2021-5

[9]
Intravesical nadofaragene firadenovec gene therapy for BCG-unresponsive non-muscle-invasive bladder cancer: a single-arm, open-label, repeat-dose clinical trial.

Lancet Oncol. 2021-1

[10]
Delaying BCG immunotherapy onset after transurethral resection of non-muscle-invasive bladder cancer is associated with adverse survival outcomes.

World J Urol. 2021-7

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