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表1 膀胱癌的分期。GC: Gemcitabine plus cisplatin。MVAC: Methotrexate， vinblastine

 

膀胱癌的分期目前膀胱癌的分期推荐采用2017年AJCC发布的第八版为标准（表1），我们通常将膀胱癌分成非肌层浸润性或是肌层浸润性（T2以上）来决定后续的治疗目前已不建议使用表浅性膀胱癌这个名词表1 膀胱癌的分期（2017 AJCC 8th edition）。

肿瘤细胞分化的恶性度：WHO 2016年分级标准将尿路上皮肿瘤分为低度恶性倾向尿路上皮乳头状肿瘤（PUNLMP）、低分级尿路上皮癌（LG）、高分级尿路上皮癌（HG）原位癌（Carcinoma in situ;CIS）

CIS是一种平坦状、高度恶性、非浸润性尿路上皮癌非肌层浸润性膀胱癌（NMIBC）诊断及处理原则

经尿道膀胱肿瘤切除术（TURBT）操作注意事项及步骤：在麻醉下可考虑行双合触诊，但若明显为非浸润性或明显为浸润性肿瘤，则可不做做膀胱镜检查时应从尿道观察到膀胱内应将膀胱完整的检查一遍如果前列腺尿道黏膜异常，此部位应进行活检。

如果膀胱黏膜表面有部位异常，应做冷冻切片活检切除膀胱肿瘤手术报告应完整记录术中的发现病理检查单应精确描述送检标本，以利病理评估

NMIBC风险分类及治疗

膀胱内灌注化疗包括丝裂霉素C、表柔比星、吉西他滨及多西他赛BCG灌注的禁忌症TURBT后两周内病人有明显肉眼可见的血尿留置尿管时有损伤有尿路感染的症状BCG失败后的治疗选择

Via：2019年EAU指南对非肌层浸润性膀胱癌指引NMIBC的随访

注：膀胱镜检查的频率目前尚无高级别医学文献证据支持肌层浸润性膀胱癌（MIBC）处理原则对于肌层浸润性膀胱癌，建议做根治性膀胱切除手术，开放手术和腹腔镜手术皆可建议做两侧广泛性盆腔淋巴结清扫任何一种尿流改道对于肿瘤的预后都没有差别。

转移性膀胱癌约有一半的MIBC在术后复发，只有30%的病人是局部复发，意味着大部分病人都是转移性复发约有10%～15%的病人是一开始诊断时就存在转移，这一类的病人主要的治疗方式都是化疗处理原则化学药物治疗。

GC: Gemcitabine plus cisplatin（吉西他滨+顺铂）PCG: Paclitaxel, cisplatin,gemcitabine（紫杉醇、顺铂、吉西他滨）MVAC: Methotrexate, vinblastine, adriamycin plus cisplatin（甲氨蝶呤、长春碱、阿霉素加顺铂）

G-CSF: granulocyte colony-stimulating factor（粒细胞集落刺激因子）MIBC的随访与治疗

参考资料：1.M.Babjuk,M.Burger,E.Compérat,et.al.Guidelines on Non-muscle-invasive Bladder Cancer (Ta,T1 and CIS). European Association of Urology;2019.

2.J.A.Witjes,M.Bruins,R.Cathomas,E.Comperat,et.al.Guidelines on Muscle-invasive and Metastatic Bladder Cancer.European Association of Urology;2019.

3.Thomas W.Flaig,Philippe E.Spiess, Neeraj Agarwal,et.al. NCN Guidelines Version 4.2019 Bladder Cancer.

4.Anderson,C,et al. A 10-ltem Checklist lmproves Reporting of Critical Procedural Elements during Transurethral Resection of Bladder Tumor. J Urol, 2016.196: 1014.

5.Sylvester,R.J,et al.Predicting recurrence and progression in individual patients with stage TaT1bladder cancer using EORTC risk tables:a combined analysis of 2596 patients from seven EORTC trials. Eur Urol,2006.49:466.

6.Oddens,J,et al.Final results of an EORTC-GU cancers group randomized study of maintenance bacillus Calmette-Guerin in intermediate-and high-risk Ta,T1 papillary carcinoma of the urinary bladder:one-third dose versus full dose and 1 year versus 3years of maintenance.Eur Urol,2013.63: 462

7. Hautmann,R.E,et al.Radical cystectomy for urothelial carcinoma of the bladder without neoadjuvant or adjuvant therapy: long-term results in 1100 patients. Eur Urol, 2012.61:1039.

8.James,N.D.,et al.Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer.New Engl J Med,2012.366:1477.

9.Ploussard,G.,et al.Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer:a systematic review. Eur Urol, 201466:120.

10.Bamias,A.,et al.Prospective,open-label,randomized,phase lll study of two dose-dense regimens MVAC versus gemcitabine/cisplatin in patients with inoperable,metastatic or relapsed urothelial cancer:a Hellenic Cooperative Oncology Group study (HE 16/03).Ann Oncol,2013.24:

11. Balar,A.V.,et al.Atezolizumab as first-ine treatmentin cisplatin-ineligible patients with locally advancedand metastatic urothelial carcinoma:a single-arm multicentre,phase 2 trial. Lancet,2017. 389:67.

12.Balar,A.V.,et al. First-line pembrolizumab in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer(KEYNOTE-052):a multicentre,single-arm,phase 2 study.Lancet Oncol.2017 Nov;18(11):1483-1492

13.Bellmunt,J,et al.Pembrolizumab as Second-Line Therapy for Advanced Urothelial Carcinoma.N Engl J Med,2017.376:1015.

14.Powles,T,et al.Atezolizumab versus chemotherapy in patients with platinum-treated locally advanced or metastatic urothelial carcinoma(lMvigor211):a multicentre,open-label,phase 3 randomised controlled trial.Lancet,2018.391:748.

15.Sharma,P.,et al.Nivolumab in metastatic urothelial carcinoma after platinum therapy (CheckMate 275):a multicentre,single-arm,phase 2 trial. Lancet Oncol, 2017.18:312.

16.Abufaraj,M.,et al.The Role of Surgery in Metastatic Bladder Cancer:A Systematic Review.Eur Urol,2018.73:543.

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