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