Kurth K H
Department of Urology, University of Amsterdam, The Netherlands.
Eur Urol. 1997;31 Suppl 1:10-9. doi: 10.1159/000474526.
The detection of potentially highly curable low-grade bladder cancers by noninvasive techniques remains an unsolved problem. Conventional cytology detects such tumors with 50% sensitivity, the addition of DNA image analysis cytometry in patients with previous transitional cell superficial bladder carcinoma increases the chance to detect low-grade tumors. The specificity and sensitivity of detection of low-grade bladder tumors can be further improved by quantitative fluorescence image analysis using antibodies directed against tumor-associated antigens. The chance of subsequent tumor following initial complete resection is significantly lowered compared to resection alone by either intravesical adjuvant chemotherapy or immunotherapy. BCG is superior to chemotherapy in patients with high risk for recurrence, adjuvant intravesical chemotherapy does not prevent progression to > T1 when compared with resection alone, BCG may delay progression and the need for cystectomy in high-risk patients (T1, Cis or Cis associated with papillary Ta/T1, > 3 recurrences/year, grade 3 tumors). Oral medication with bropirimine (an interferon inducer) induced complete response in patients with carcinoma in situ, oral Lactobacillus casei prolonged the recurrence-free interval to 1.8 times that in the control group. New compounds for adjuvant treatment of superficial bladder tumors are best first tested on their ablative effects (marker lesion, Cis) prior to be used for prophylaxis.
通过非侵入性技术检测潜在可高度治愈的低级别膀胱癌仍然是一个未解决的问题。传统细胞学检测此类肿瘤的灵敏度为50%，在既往有移行细胞浅表性膀胱癌的患者中添加DNA图像分析细胞术可增加检测低级别肿瘤的机会。使用针对肿瘤相关抗原的抗体进行定量荧光图像分析可进一步提高低级别膀胱肿瘤检测的特异性和灵敏度。与单纯手术切除相比，通过膀胱内辅助化疗或免疫疗法，初始完全切除后后续发生肿瘤的几率显著降低。对于复发风险高的患者，卡介苗优于化疗；与单纯手术切除相比，辅助膀胱内化疗不能预防进展至>T1期，卡介苗可能会延迟高危患者（T1期、原位癌或与乳头状Ta/T1相关的原位癌、每年复发>3次、3级肿瘤）的进展及膀胱切除术的必要性。口服布罗匹明（一种干扰素诱导剂）可使原位癌患者出现完全缓解，口服干酪乳杆菌可使无复发生存期延长至对照组的1.8倍。用于浅表膀胱肿瘤辅助治疗的新化合物在用于预防之前，最好先对其消融效果（标记病变、原位癌）进行测试。
