Li Yuxiao, Huang Suyuelin, Ju Wenlong, Lu Dingheng, Sun Jiazhu, Zhan Weitao, Niu Xinyang, Shi Yuchen, Yu Kai, Liu Ben
Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Cancer Center, Zhejiang University, Hangzhou, China.
Asian J Urol. 2025 Apr;12(2):217-231. doi: 10.1016/j.ajur.2024.09.006. Epub 2024 Dec 5.
Bladder cancer (BCa) is a prevalent malignant tumor in the urinary system. Molecular subtyping, utilizing molecular characteristics, represents a novel classification system that has demonstrated its efficacy in tumor diagnosis and treatment. Given the critical role of molecular subtyping in the BCa treatment, acquiring a comprehensive understanding is imperative for guiding treatment decisions, optimizing risk assessment systems, and ultimately improving patient prognosis.
In this review, we provide a comprehensive overview of the research progress in molecular subtyping of BCa, with a primary focus on discussing its utility in guiding various treatment modalities including neoadjuvant chemotherapy, neoadjuvant immunotherapy, and targeted therapy. In addition, this review also covers the trimodality treatment, antibody-drug conjugates, and the treatment of small cell BCa.
We present a comprehensive overview of the responsiveness or resistance of different molecular subtypes of BCa to various therapeutic modalities. The basal subtype demonstrates favorable sensitivity to neoadjuvant chemotherapy across multiple classification systems, whereas the luminal infiltrated subtype exhibits potential susceptibility to immunotherapy. In terms of targeted therapy, the basal-like and the basal/squamous subtypes in some classifications have shown notable responsiveness to epidermal growth factor receptor-targeted therapy. Moreover, the luminal subtype in the University of Texas M.D. Anderson Cancer Center classification, the luminal papillary subtypes according to the Cancer Genome Atlas Research Network classification in 2017, and the luminal unstable type in the 2019 Molecular Subtyping classification show potential for the fibroblast growth factor receptor 3-targeted treatment.
The significance and impact of BCa molecular subtyping in guiding treatment, evaluating progression, and predicting prognosis are increasingly acknowledged. Accurate subtyping and broad application can bring good benefits to clinical decision-making, risk assessment, and prognostic evaluation.
膀胱癌（BCa）是泌尿系统中一种常见的恶性肿瘤。利用分子特征进行分子亚型分类是一种新型分类系统，已在肿瘤诊断和治疗中证明了其有效性。鉴于分子亚型分类在BCa治疗中的关键作用，全面了解对于指导治疗决策、优化风险评估系统并最终改善患者预后至关重要。
在本综述中，我们全面概述了BCa分子亚型分类的研究进展，主要侧重于讨论其在指导包括新辅助化疗、新辅助免疫治疗和靶向治疗在内的各种治疗方式中的应用。此外，本综述还涵盖了三联疗法、抗体药物偶联物以及小细胞BCa的治疗。
我们全面概述了BCa不同分子亚型对各种治疗方式的反应性或耐药性。在多个分类系统中，基底亚型对新辅助化疗表现出良好的敏感性，而管腔浸润亚型对免疫治疗表现出潜在的易感性。在靶向治疗方面，某些分类中的基底样和基底/鳞状亚型对表皮生长因子受体靶向治疗表现出显著的反应性。此外，德克萨斯大学MD安德森癌症中心分类中的管腔亚型、2017年癌症基因组图谱研究网络分类中的管腔乳头状亚型以及2019年分子亚型分类中的管腔不稳定型显示出成纤维细胞生长因子受体3靶向治疗的潜力。
BCa分子亚型分类在指导治疗、评估进展和预测预后方面的意义和影响日益得到认可。准确的亚型分类和广泛应用可为临床决策、风险评估和预后评估带来良好益处。
