Bladder-conserving therapy for muscle invasive bladder cancer: current status and future

Radical cystectomy plus pelvic lymph node dissection is the gold standard treatment for muscle invasive bladder cancer. However, the patients with severe medical complications cannot tolerate the operation, and the incidence rates of short- and long-term postoperative complications are quite high. In order to achieve good tumor control while preserve bladder function and maintain good quality of life, bladder preservation treatment is actively explored in China and at abroad. At present, triple or multiple combination therapy, including maximum transurethral bladder tumor resection, chemotherapy and external irradiation and radiotherapy, is mostly adopted. Studies have shown that its long-term tumor control effect is similar to that of cystectomy, and it has been recommended as an effective treatment option for muscle invasive bladder cancer by domestic and foreign specialized diagnosis and treatment guidelines. In the course of comprehensive treatment for bladder preservation, the efficacy of the treatment is currently evaluated by liquid biopsy, radiography, cystoscopic biopsy or surgical thoroughness of transurethral bladder tumor resection, and timely salvage radical resection can be performed for the patients with poor response. In addition, neoadjuvant chemotherapy may have no effect on the overall survival of the patients after bladder preservation combination therapy, but it can be used as a screening method for treatment response, and early radical surgery is recommended for patients with poor response. There is no standard treatment plan for bladder preservation combination therapy, and it is difficult to determine the best treatment population. Randomized controlled studies and long-term follow-up trial of the combination treatment in comparison with radical bladder resection need to be carried out. In view of the breakthrough efficacy of immune checkpoint inhibitors in the treatment of advanced uroepithelial carcinoma, the combination of immune checkpoint inhibitors and radiotherapy and chemotherapy may also be the direction of future research.