在三种疗法治疗后,膀癌复发的管理
Nahed Damaj1, Nabih Naim1, Ahmad Saad1
1Department of Hematology-Oncology, Hôtel Dieu de France University Hospital, Faculty of Medicine-Saint Joseph University of Beirut, Beirut, Lebanon.
Frontiers in oncology
|October 17, 2025
概括
肌肉侵入性膀癌 (MIBC) 的三种疗法 (TMT) 显示出良好的局部控制,但复发需要谨慎管理. 非肌肉侵入性复发是可以管理的,而肌肉侵入性复发通常需要救援囊切除术.
科学领域:
- 尿瘤学 尿瘤学
- 膀癌研究 膀癌研究
- 癌症治疗策略 癌症治疗策略
背景情况:
- 肌肉侵入性膀癌 (MIBC) 治疗传统上涉及激进囊切除术.
- 三种疗法 (TMT),包括通过尿道切除 (TUR),化疗 (CT) 和放射治疗 (RT),为MIBC提供了保持膀的替代方案.
- TMT实现了高的完全响应率 (50-80%),但具有显著的复发率 (20-30%).
研究的目的:
- 审查当前关于MIBCTM后复发模式的证据.
- 为了区分非肌肉侵入性 (NMIBC) 与肌肉侵入性 (MIBC) 后TMT复发的结果和管理策略.
- 为了突出治疗不确定性的患者不适合或下降的救援囊管切除术.
主要方法:
- 审查现有的文献和临床证据在TMT后膀癌复发.
- 复发类型的分析:非肌肉侵入性膀癌 (NMIBC) 和肌肉侵入性膀癌 (MIBC).
- 对不同复发情景的治疗结果的评估.
主要成果:
- 在TMT后的NMIBC复发通常可以通过重复的TURBT和静脉BCG来控制,而不会对生存产生不利影响.
- 在符合条件的患者中,MIBC复发通常需要救援囊切除术,其结果与初级手术相当.
- 在不适合或拒绝囊切除术的患者中,MIBC复发的治疗缺乏明确的指导方针,通常依赖于外推的全身疗法.
结论:
- 在MIBC的TMT后的复发模式有很大的差异,影响后续的治疗和预后.
- 保守的方法对NMIBC复发是有效的,保持膀功能和生存.
- 针对特定患者群体MIBC复发的最佳治疗策略仍然是一个需要进一步指导方针开发和研究的领域.
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