Joffe Benjamin I, Christin John R, Le Coz Clémentine, Pingle Srinath-Reddi, Wei Alexander Z, Runcie Karie D, Stein Mark N, DeCastro Guarionex Joel, Anderson Christopher B, McKiernan James M, Lenis Andrew T
Department of Urology, Columbia University Vagelos College of Physicians and Surgeons, 161 Fort Washington Avenue, 11th Floor Herbert Irving Pavilion, New York, NY, 10032, USA.
Division of Hematology/Oncology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA.
Curr Urol Rep. 2025 Apr 10;26(1):36. doi: 10.1007/s11934-025-01264-6.
To review the landscape of bladder preservation management and active surveillance for those who achieve clinical complete response to neoadjuvant chemotherapy.
Multiple cohorts of patients with clinical complete response report overall survival rates over 80% multiple years after treatment without cystectomy. Most recently, prospective clinical trials have been pursuing clinical complete response as a valid primary endpoint. Recent advances in immunotherapy and molecular biomarkers present new horizons in expanding the potential patient population as well as accuracy in prediction of pathologic complete response. While neoadjuvant chemotherapy followed by radical cystectomy is the standard of care for muscle-invasive bladder cancer, interest in active surveillance is growing as evidenced by the increasing number of studies. Accumulating evidence and new prospective data suggest this could be a plausible option in the future. These cohorts remain highly selected, thus generalizability is still under investigation.
回顾对新辅助化疗取得临床完全缓解的患者进行膀胱保留管理和主动监测的情况。
多个临床完全缓解患者队列报告称，在未进行膀胱切除术的情况下，多年后的总生存率超过80%。最近，前瞻性临床试验一直将临床完全缓解作为一个有效的主要终点。免疫疗法和分子生物标志物的最新进展为扩大潜在患者群体以及预测病理完全缓解的准确性带来了新的前景。虽然新辅助化疗后行根治性膀胱切除术是肌层浸润性膀胱癌的标准治疗方法，但越来越多的研究表明，对主动监测的兴趣正在增加。越来越多的证据和新的前瞻性数据表明，这在未来可能是一个可行的选择。这些队列的入选标准仍然很高，因此其普遍性仍在研究中。
