Bladder preservation in muscle-invasive bladder cancer: a comprehensive review

ABSTRACT Background Standard management of muscle-invasive bladder cancer involves radical cystectomy with pelvic lymph node dissection. However, patients may be ineligible for surgery or may wish to avoid the morbidity of cystectomy due to quality of life concerns. Bladder preservation therapies have emerged as alternatives treatment options that can provide comparable oncologic outcomes while maintaining patients’ quality of life. Objective To review bladder preservation therapies, patient selection criteria, and functional and oncologic outcomes for BPT in muscle-invasive bladder cancer. Materials and Methods We conducted a comprehensive literature review of bladder preservation therapies in Pubmed and Embase. Discussion The ideal patient for BPT has low-volume T2 disease, absence of CIS, absence of hydronephrosis, and a maximal TURBT with regular surveillance. Technological advancements involving cancer staging, TURBT technique, and chemotherapy and radiation therapy regimens have improved BPT outcomes, with oncologic outcomes now comparable to those of radical cystectomy. Advancements in BPT also includes a heightened focus on improving quality of life for patients undergoing bladder preservation. Preservation strategies with most evidence for use include trimodality therapy and partial cystectomy with pelvic lymph node dissection. Conclusions This review highlights the breadth of strategies that aim to preserve a patient’s bladder while still optimizing local tumor control and overall survival. Future areas for innovation include the use of predictive biomarkers and implementation of immunotherapy, moving the field towards patient-tailored care.

摘要
背景 肌层浸润性膀胱癌（muscle-invasive bladder cancer）的标准管理方案为根治性膀胱切除术（radical cystectomy）联合盆腔淋巴结清扫术（pelvic lymph node dissection）。然而部分患者无法耐受手术治疗，或出于生活质量顾虑希望规避膀胱切除术带来的手术并发症。膀胱保留治疗（bladder preservation therapies, BPT）现已成为替代治疗选择，可在维持患者生活质量的同时实现与根治性手术相当的肿瘤学结局。
目的 本综述旨在探讨肌层浸润性膀胱癌患者的膀胱保留治疗方案、患者筛选标准，以及该治疗方式的功能结局与肿瘤学结局。
材料与方法 我们在PubMed与Embase数据库中针对膀胱保留治疗开展了全面的文献回顾。
讨论 理想的膀胱保留治疗候选患者应满足以下条件：肿瘤体积较小的T2期病变、无原位癌（Carcinoma In Situ, CIS）、无肾积水，且已接受彻底的经尿道膀胱肿瘤切除术（Transurethral Resection of Bladder Tumor, TURBT）并定期接受随访监测。肿瘤分期评估、TURBT技术、化疗与放疗方案相关的技术进步已改善了膀胱保留治疗的临床结局，目前其肿瘤学结局已与根治性膀胱切除术相当。此外，膀胱保留治疗领域的进展还更加注重提升接受保膀胱治疗患者的生活质量。目前证据最为充分的保膀胱策略包括三联疗法（trimodality therapy），以及联合盆腔淋巴结清扫术的膀胱部分切除术。
结论 本综述梳理了各类旨在保留患者膀胱，同时优化局部肿瘤控制与总生存期的治疗策略。未来的创新方向包括预测性生物标志物（predictive biomarkers）的应用与免疫治疗（immunotherapy）的推广，推动该领域向个体化患者诊疗模式发展。