编者按：膀胱癌是一种生物学上具有多样性的疾病，其分类在指导治疗中起着关键作用。然而目前膀胱癌分类仍主要基于临床病理特征或分期，分子分型尚无标准。在2025年欧洲泌尿外科协会（EAU）大会上，来自美国北卡罗来纳大学教堂山分校莱恩博格综合癌症中心的Jeffrey S. Damrauer教授，与我们分享了关于不同类型的膀胱癌对治疗的反应、新辅助治疗的作用以及保留膀胱策略日益增长的可能性的关键见解。

01

《肿瘤瞭望-泌尿时讯》

是否存在不同类型的膀胱癌？如果是，不同类型将如何影响治疗？

Dr. Jeffrey S. Damrauer：这是一个很好的问题。膀胱癌有几种不同的分类方式。第一种是显微镜下（观察肿瘤）的外观。尽管有几种所谓的组织学亚型，但主要类型是尿路上皮癌，它占所有泌尿肿瘤的约90%。

接下来的分类——可能也是最具临床意义的——肿瘤是否为非肌层浸润性或肌层浸润性。这实际上决定了几件事情：首先，肿瘤如果是向膀胱腔内生长侵及膀胱肌层，则是一种更严重的疾病，通常会用新辅助治疗，然后通过手术切除膀胱来治疗。非肌层浸润性疾病虽然复发率相对较高，但通常可以通过一种侵入性不太大的方式将其刮除，同时保留膀胱。

UroStream: Are there different kinds of bladder cancers and if so, how does the type affect the treatment?

Dr. Jeffrey S. Damrauer: That's a great question. There are a few different classifications of bladder cancer.The first is kind of what it looks like under a microscope. Although there are several different so-called histologic subtypes, the main one is urothelial cancer, and that makes up about 90% of all tumors.

The next—and probably most clinically impactful—is whether or not it's non-muscle-invasive or muscle-invasive. That really dictates a few things: first, whether the tumor grows into the bladder lumen or through the muscle.If it grows into the muscle, it's a much more serious disease and is usually treated with neoadjuvant therapy, followed by surgery to remove the bladder.Non-muscle-invasive disease, although it can recur fairly frequently, can often just be scooped out in a less invasive manner, with the ability to retain your bladder.

02

《肿瘤瞭望-泌尿时讯》

膀胱癌新辅助治疗的目的是什么？

Dr. Jeffrey S. Damrauer：新辅助治疗——即在根治性膀胱切除术（切除膀胱）之前进行的治疗——主要是试图消灭那些从肿瘤上脱落并在全身各处的细胞。这样，我们不仅可以缩小主要肿瘤的大小，还可以消除可能导致术后在其他器官出现转移或生长的细胞。

UroStream: What is the purpose of neoadjuvant therapy?

Dr. Jeffrey S. Damrauer: So, neoadjuvant therapy—or therapy given prior to radical cystectomy (removing the bladder)—is mainly about trying to kill off any small cells that have broken away from the tumor and could be throughout the body.This way, we can reduce the main tumor size but also eliminate cells that may lead to metastases or growths in other organs following surgery.

03

《肿瘤瞭望-泌尿时讯》

所有肌层浸润性膀胱癌患者都需要切除膀胱吗？

Dr. Jeffrey S. Damrauer：现在有很多研究集中在保留膀胱上。决定是否可以避免膀胱切除术的主要因素之一是新辅助治疗的成功与否。如果化疗后肿瘤完全消失，越来越多的研究表明，通过密切监测或后续放疗，患者可能可以安全地保留膀胱。

UroStream: Do all patients with MIBC need their bladder removed?

Dr. Jeffrey S. Damrauer: There’s a lot of focus now on being able to retain the bladder.One of the main factors in deciding whether or not you can avoid cystectomy is the success of neoadjuvant therapy.If, after chemotherapy, the tumor is completely gone, there’s growing research to suggest that—with close monitoring or follow-up radiation therapy—patients may be able to safely retain their bladder.

04

《肿瘤瞭望-泌尿时讯》

哪些不同的因素会影响膀胱癌治疗的疗效？

Dr. Jeffrey S. Damrauer：目前有很多研究正在进行，以了解哪些因素会影响治疗的成功。肿瘤内发生的不同突变会影响其对治疗的敏感性。此外，肿瘤内或周围的免疫细胞数量——所谓的肿瘤微环境——被认为是重要的标志物。随着许多新疗法的出现，很多因素取决于肿瘤的特性——哪些基因或蛋白质正在表达，以及我们是否可以针对这些靶点进行治疗。

UroStream: What are the different factors that can affect the efficacy of bladder cancer therapy?

Dr. Jeffrey S. Damrauer: There’s a lot of research going on right now to understand what factors influence the success of therapy.Different mutations that occur within the tumors can affect how sensitive they are to treatment.Also, the amount of immune cells that are within or around the tumor—its so-called microenvironment—are thought to be important markers.Now, with many new therapies coming online, a lot depends on the properties of the tumor—what genes or proteins are being expressed, and whether we can target those specifically.

05

《肿瘤瞭望-泌尿时讯》

您认为哪些新疗法比较有前景？

Dr. Jeffrey S. Damrauer：正如我所说，现在有很多新疗法属于精准医疗范畴——它们针对每个肿瘤的个体特性。包括抗体药物偶联物，在转移性或晚期膀胱癌中显示出很好的疗效。这些药物可靶向肿瘤上的特定标志物，并将药物直接输送至肿瘤。还有正在开发的用于非肌层浸润性肿瘤的病毒疗法。这些方法都专注于患者或肿瘤的特定属性——真正旨在只杀死膀胱癌细胞，同时（减少对正常组织细胞的损伤），使副作用最小。

UroStream: What are the promising new therapies?

Dr. Jeffrey S. Damrauer: As I said, there are a lot of new therapies now that fall under precision medicine—they target the individual nature of each tumor. These include antibody-drug conjugates, which have shown to be very successful in the metastatic setting or in advanced bladder cancer. They target specific markers on the tumor and deliver drugs directly to it. There are also viral therapies being developed for non-muscle-invasive cancer. Many of these approaches focus on patient- or tumor-specific properties—really aiming to kill only bladder cancer cells while producing the least amount of side effects.

（来源：《肿瘤瞭望-泌尿时讯》编辑部）

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