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肌层浸润性尿路上皮(移行细胞)膀胱癌的新辅助疗法和保留膀胱方案

Author
Derek Raghavan, MD, PhD, FACP, FASCO
Section Editors
Philip W Kantoff, MD
Seth P Lerner, MD
Deputy Editor
Don S Dizon, MD, FACP
Translators
范欣荣, 副主任医师，副教授

引言

世界范围内约有390,000例膀胱癌病例，并有150,000例因此死亡。在世界发达地区，如北美和西欧，这些膀胱癌主要为尿路上皮性。尽管进行了根治性膀胱切除术，仍有约一半的深部肌层浸润性膀胱癌[累及固有肌层(T2)、膀胱周围组织(T3)或盆腔结构(T4)]患者在2年内出现转移性病变，且通常会死于该病[1,2]。 (参见“膀胱尿路上皮(移行细胞)癌的流行病学和危险因素”，关于‘流行病学’一节)

肌层浸润性膀胱癌患者的当前治疗方法是一种多方式治疗方法，包括手术、新辅助化疗及对于特定患者行以保留膀胱为目的的新辅助放化疗。然而，尽管证据表明，与单独局部区域治疗相比，以顺铂为基础的新辅助化疗可改善患者生存，但实际上，行根治性膀胱切除术的患者中不到20%接受了新辅助化疗[3-6]。

本专题重点讨论肌层浸润性尿路上皮膀胱癌的多方式治疗。膀胱癌的外科治疗、非肌层浸润性膀胱癌的治疗、辅助化疗对膀胱癌患者中的作用以及转移性膀胱癌的治疗将单独详细讨论。 (参见“Radical cystectomy and bladder-sparing treatments for urothelial bladder cancer”和“辅助化疗在肌层浸润性膀胱尿路上皮癌中的应用”和“非肌层浸润性膀胱癌的治疗”和“Treatment of metastatic urothelial cancer of the bladder and urinary tract”)

治疗方法概述

根治性膀胱切除术伴双侧盆腔淋巴结切除术仍是肌层浸润性膀胱癌患者的标准治疗方案。但是，肌层浸润性膀胱癌患者行单独膀胱切除术后复发率较高，这导致了新辅助治疗的应用。根据患者是否适合保留膀胱方案而选择合适的治疗方案：  

●对于大多数将接受根治性膀胱切除术的临床分期为T2-4a期膀胱癌患者，我们推荐新辅助化疗而非新辅助放疗(radiation therapy, RT)或单独初始手术治疗。已显示新辅助化疗可改善此类人群的生存。 (参见下文‘接受根治性膀胱切除术的患者’)

                  

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-16.
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