Zhong Honglin, He Wei, Mo Miao, Tong Shiyu, Wang Yinzhao, Wang Yuhang, Liu Xuhao, Zhu Wenhao, Shen Zhengchao, Huang Zhongfu, Ou Zhenyu, Chen Minfeng
Department of Urology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China.
Bladder (San Franc). 2025 Jun 5;12(3):e21200053. doi: 10.14440/bladder.2024.0065. eCollection 2025.
Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer (MIBC). However, its high perioperative mortality and significant impact on quality of life have led many patients to opt for bladder-preserving approaches, which currently lack a standardized treatment protocol.
This study evaluated the efficacy and feasibility of bladder-preserving therapy using thulium laser maximal transurethral resection of bladder tumors (TURBT) combined with neoadjuvant therapy and immunotherapy in MIBC patients.
A retrospective analysis was conducted on 46 MIBC patients treated with neoadjuvant therapy followed by thulium laser maximal TURBT at a single center between January 2021 and October 2024. Patients had received neoadjuvant immunotherapy in combination with chemotherapy or antibody-drug conjugate before maximal thulium laser TURBT. Those who achieved a complete clinical response were allowed to pursue either bladder preservation or RC. Patients choosing bladder-preserving therapy were either given maintenance immunotherapy or put on observation. Bladder-intact disease-free survival (BIDFS) was assessed through Kaplan-Meier analysis, and Cox regression identified factors influencing BIDFS.
Among the 46 patients, 95.7% remained alive, and 82.6% demonstrated no evidence of cancer with bladder function preserved. The estimated 2-year BIDFS rate was 84.2%, and T stage and maintenance immunotherapy were identified as two independent predictors of BIDFS. Patients receiving immunotherapy were at a significantly reduced risk of recurrence compared to their counterparts under observation.
Thulium laser maximal TURBT, combined with neoadjuvant therapy and maintenance immunotherapy, is a promising bladder-preserving approach that helps MIBC patients attain favorable BIDFS and quality of life.
根治性膀胱切除术（RC）是肌层浸润性膀胱癌（MIBC）的标准治疗方法。然而，其较高的围手术期死亡率以及对生活质量的重大影响，导致许多患者选择保留膀胱的治疗方法，而目前这些方法缺乏标准化的治疗方案。
本研究评估了采用铥激光最大经尿道膀胱肿瘤切除术（TURBT）联合新辅助治疗和免疫治疗对MIBC患者进行保留膀胱治疗的疗效和可行性。
对2021年1月至2024年10月在单一中心接受新辅助治疗后行铥激光最大TURBT的46例MIBC患者进行回顾性分析。患者在接受最大铥激光TURBT之前接受了新辅助免疫治疗联合化疗或抗体药物偶联物治疗。那些获得完全临床缓解的患者可以选择保留膀胱或行RC。选择保留膀胱治疗的患者要么接受维持免疫治疗，要么进行观察。通过Kaplan-Meier分析评估膀胱完整无病生存期（BIDFS），并通过Cox回归确定影响BIDFS的因素。
46例患者中，95.7%存活，82.6%无癌症证据且膀胱功能得以保留。估计2年BIDFS率为84.2%，T分期和维持免疫治疗被确定为BIDFS的两个独立预测因素。与接受观察的患者相比，接受免疫治疗的患者复发风险显著降低。
铥激光最大TURBT联合新辅助治疗和维持免疫治疗是一种有前景的保留膀胱的方法，有助于MIBC患者获得良好的BIDFS和生活质量。
