肌层浸润性膀胱尿路上皮癌的治疗进展

Progress in the treatment of muscle-invasive bladder urothelial carcinoma

膀胱癌是全球常见的癌症,90%以上的膀胱癌为尿路上皮癌(urothelial carcinoma,UC)。UC的治疗与其进展阶段密切相关,肿瘤一旦出现肌层浸润,5年生存率不足40%,且有很高的复发或进展风险,即使接受了根治性手术,仍有50%的患者术后复发,大多数复发时远处转移形成转移性膀胱癌。目前,肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)的治疗标准是在新辅助化疗后行根治性膀胱切除术,但术后患者生活质量欠佳。保留膀胱的综合治疗因其良好的肿瘤反应率和无病生存期而越来越受欢迎。全身化疗仍是局部晚期或转移性膀胱癌的治疗标准,新型药物免疫检查点抑制剂的批准为化疗进展后的晚期患者提供了治疗新方案。此外,FDA授予了Enfortumab Vedotin和Erdafitinib两种药物突破性疗法认定。本文将就各种疗法在肌层浸润性膀胱尿路上皮癌治疗中的地位及应用进展进行综述。

Bladder cancer is the most common cancer in the world,and more than 90%of bladder cancer is urothelial carcinoma(UC).The treatment of UC is closely related to the progression stage.Once the tumor has muscular invasion,the 5-year survival rate is less than 40%,and there is a high risk of recurrence or progression.Even after radical surgery,50%of patients still have recurrence.Most patients have distant metastases after tumor recurrence,forming metastatic bladder cancer.At present,the standard of treatment for muscle-invasive bladder cancer(MIBC)is radical cystectomy after neoadjuvant chemotherapy,but the quality of life of patients after surgery is poor.The comprehensive treatment of bladder preservation is becoming more and more popular because of its good tumor response rate and disease-free survival.Systemic chemotherapy is still the standard of treatment for advanced or metastatic bladder cancer,and the approval of new drug immune checkpoint inhibitors provides new treatment options for advanced patients after chemotherapy progresses.Furthermore,Breakthrough Therapy Designations have been granted for Enfortumab Vedotin and Erdafitinib by FDA.This article will review the status and application of various therapies in the treatment of muscle-invasive bladder urothelial carcinoma.