Claps Francesco, Biasatti Arianna, Di Gianfrancesco Luca, Ongaro Luca, Giannarini Gianluca, Pavan Nicola, Amodeo Antonio, Simonato Alchiede, Crestani Alessandro, Cimadamore Alessia, Hurle Rodolfo, Mertens Laura S, van Rhijn Bas W G, Porreca Angelo
Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1006 BE Amsterdam, The Netherlands.
Department of Urology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
J Clin Med. 2024 Jul 25;13(15):4349. doi: 10.3390/jcm13154349.
Bladder cancer (BC) is the tenth most commonly diagnosed malignancy worldwide. In approximately 25% of cases, it presents as a muscle-invasive disease, requiring a radical treatment. Traditionally, the mainstay of treatment has been radical cystectomy (RC), but in the last decade, bladder-sparing treatments have been gaining growing interest. In particular, trimodal therapy (TMT) seems to yield survival results comparable to RC with less morbidity and better quality of life (QoL) outcomes. In this scenario, we aimed at shedding light on the role of the histological subtypes (HS) of BC and their prognostic significance in muscle-invasive BC (MIBC), treated either surgically or with TMT. We performed a narrative review to provide an overview of the current literature on this topic. When compared with patients diagnosed with conventional urothelial carcinoma (UC) of the same disease stage, survival did not appear to be significantly worse across the reports. But when sub-analyzed for separate subtype, some appeared to be independently associated with adverse survival outcomes such as the micropapillary, plasmacytoid, small-cell, and sarcomatoid subtypes, whereas others did not. Moreover, the optimal management remains to be defined, also depending on the therapeutic susceptibility of each histology. From this perspective, multi-disciplinary assessment alongside the routine inclusion of such entities in randomized clinical trials appears to be essential.
膀胱癌（BC）是全球第十大最常被诊断出的恶性肿瘤。在大约25%的病例中，它表现为肌肉浸润性疾病，需要进行根治性治疗。传统上，治疗的主要方法是根治性膀胱切除术（RC），但在过去十年中，保留膀胱的治疗方法越来越受到关注。特别是，三联疗法（TMT）似乎能产生与RC相当的生存结果，且发病率更低，生活质量（QoL）结果更好。在这种情况下，我们旨在阐明BC组织学亚型（HS）的作用及其在接受手术或TMT治疗的肌肉浸润性膀胱癌（MIBC）中的预后意义。我们进行了一项叙述性综述，以概述关于该主题的当前文献。与处于相同疾病阶段的传统尿路上皮癌（UC）患者相比，各报告中的生存率似乎并没有显著更差。但当按单独的亚型进行亚分析时，一些亚型似乎与不良生存结果独立相关，如微乳头、浆细胞样、小细胞和肉瘤样亚型，而其他亚型则不然。此外，最佳治疗方案仍有待确定，这也取决于每种组织学的治疗敏感性。从这个角度来看，多学科评估以及在随机临床试验中常规纳入这些实体似乎至关重要。
