BCG治疗失败的分类与治疗选择

Classification and Treatment Options for BCG-Failure

经尿道膀胱肿瘤电切术(TURB)后辅助膀胱内卡介苗(BCG)灌注是治疗中–高危非肌肉浸润性膀胱癌(NMIBC)的金标准。然而,仍然有相当一部分病人在卡介苗治疗后被诊断为疾病复发或进展,统称为BCG治疗失败。BCG治疗失败是一个高异质性患者群体,其中包括对卡介苗完全无反应的患者、最初有反应但后来复发的患者,以及在某些情况下由于副作用而对卡介苗不耐受的患者。各大指南均尝试将其分类,但目前仍然存在一定的争议,同时国内也缺乏相关总结。膀胱癌根治术是BCG治疗失败后的最优选择,然而在病人不适合或拒绝根治术时,治疗方案的选择仍然存在争议。本综述回顾和总结了当前BCG治疗失败的定义与分类及其目前最佳治疗选择,同时归纳了现有以及可能的膀胱癌根治术的替代选择,以期为后续的研究提供依据并指导临床。

Transurethral resection of bladder (TURB) with adjuvant intravesical Bacillus Calmette-Guerin vaccine (BCG) remains the gold standard therapy for intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC). However, there are still a considerable number of patients diagnosed with recurrence or progression of the disease after BCG treatment, which is collectively referred to as BCG-failure. BCG-failures include a heterogenous population of patients include patients with complete unresponsiveness to BCG, patients who respond initially but develop relapse and, in some cases, patients who are intolerant to BCG due to side effects. Several guidelines have tried to classify them, but there is still some controversy, and there is also a lack of relevant summary in China. Radical cystectomy (RC) should be considered as the preferred option in patients who experience a BCG-failure. However, the choice of treatment options remains controversial when patients are unsuitable for or refuse radical cystectomy. We reviewed and summarized the current definition and classification of BCG treatment failure and the current best treatment options, and summarized the current and potential alternative options, so as to provide the basis for future studies and guide clinical practice.