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期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-076743

摘要内容如下：

膀胱癌仍然是世界范围内癌症死亡的主要原因，并对患者的生活质量、发病率、死亡率和医疗保健系统的成本产生重大影响。肉眼血尿常先于膀胱癌的诊断。非肌层浸润性膀胱癌（NMIBC）最初采用经尿道膀胱肿瘤电切术（TURBT）治疗，随后采用风险分层方法辅助膀胱内治疗（IVE），总生存率为90%。然而，由于多种因素，肌层浸润性膀胱癌（MIBC）的治愈率仍然较低。NMIBC和MIBC分组是异质性的，并且具有独特的病理和分子特征。事实上，癌症基因组图谱计划（Cancer Genome Atlas Project）确定了具有不同治疗反应的MIBC的遗传驱动因子和管腔及基础分子亚型。对于NMIBC，IVE免疫疗法（主要是BCG）是高级别和高风险NMIBC的金标准治疗，以减少或预防初次TURBT后的复发和进展；新的试验包括免疫检查点抑制剂。最近完成了IVE基因治疗和IVE联合化疗，取得了可喜的成果。对于局部MIBC，基本目标是改善护理和降低膀胱切除术或膀胱保留策略后的发病率。在转移性疾病中，对基因组景观和肿瘤微环境理解的进步导致了免疫检查点抑制剂、靶向治疗和抗体-药物偶联物的实施。迫切需要制定更好的选择标准，以确定最有可能从特定治疗中获益的患者。

英文原文如下：

Abstracts

Bladder cancer remains a leading cause of cancer death worldwide and is associated with substantial impacts on patient quality of life, morbidity, mortality, and cost to the healthcare system. Gross hematuria frequently precedes the diagnosis of bladder cancer. Non-muscle-invasive bladder cancer (NMIBC) is managed initially with transurethral resection of a bladder tumor (TURBT), followed by a risk stratified approach to adjuvant intravesical therapy (IVe), and is associated with an overall survival of 90%. However, cure rates remain lower for muscle invasive bladder cancer (MIBC) owing to a variety of factors. NMIBC and MIBC groupings are heterogeneous and have unique pathological and molecular characteristics. Indeed, The Cancer Genome Atlas project identified genetic drivers and luminal and basal molecular subtypes of MIBC with distinct treatment responses. For NMIBC, IVe immunotherapy (primarily BCG) is the gold standard treatment for high grade and high risk NMIBC to reduce or prevent both recurrence and progression after initial TURBT; novel trials incorporate immune checkpoint inhibitors. IVe gene therapy and combination IVe chemotherapy have recently been completed, with promising results. For localized MIBC, essential goals are improving care and reducing morbidity following cystectomy or bladder preserving strategies. In metastatic disease, advances in understanding of the genomic landscape and tumor microenvironment have led to the implementation of immune checkpoint inhibitors, targeted treatments, and antibody-drug conjugates. Defining better selection criteria to identify the patients most likely to benefit from a specific treatment is an urgent need.

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