MIBC保膀胱治疗如何抉择未来方向
RuiyunTALK瑞赟说特邀专家：
四川大学华西医院 张朋 教授
天津医科大学第二医院 胡海龙 教授
上海市第十人民医院 鄢阳 教授
主持：
上海交通大学医学院附属仁济医院 张瑞赟 教授
| Publishes | Daily | Episodes | 5 | Founded | 7 days ago |
|---|---|---|---|---|---|
| Language |  ZH-CN | Categories | MedicineHealth & Fitness | ||
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导语：在肌层浸润性膀胱癌（MIBC）的治疗领域，保膀胱治疗正逐渐成为临床实践中的重要选项。然而，是选择彻底的根治手术，还是尽可能保留膀胱功能，这一直是临床医生和患者面临的艰难抉择。
临床需求与现实挑战张朋 教授：保膀胱治疗的需求非常大，因为它不仅涉及肿瘤的控制，还关乎患者的生活质量。然而，保膀胱治疗对患者的依从性和经济状况要求较高。在实际临床实践中，医生需要综合考虑患者的个体情况，包括其经济能力、心理准备和对治疗的期望，来制定最适合的治疗方案。
天时地利与人和，推进保膀胱治疗的有利条件胡海龙 教... more
导语：在肌层浸润性膀胱癌（MIBC）的保膀胱治疗中，ADC药物的应用正逐渐成为焦点。然而，ADC药物的长期使用带来了新的挑战：是追求疗效的持久性，还是强化安全性管理？这个问题的答案可能因患者的具体情况而异。
疗效持久性与安全性管理的权衡张朋 教授：在临床实践中，能够完成全程化疗的患者并不多，因为副作用常常限制了治疗的持续性。对于ADC药物，虽然其靶向性更强，但本质上仍属于化疗药物，长期使用可能导致耐药性和累积毒性。因此，在制定治疗方案时，必须综合考虑患者的耐受性和治疗目标。
个体化治疗方案的制定... more
导语：在肌层浸润性膀胱癌（MIBC）的治疗领域，针对HER2低表达患者的选择正成为一个关键问题。是坚守传统的铂类化疗，还是拥抱新兴的ADC靶向治疗？这一决策不仅影响患者的治疗效果，还关乎其生活质量。今天，我们邀请到几位专家，共同探讨这一难题。
铂类化疗的基础地位与局限张朋 教授：如果患者能够耐受铂类化疗，通常仍建议优先选择这一传统方案。尽管ADC药物如RC48在HER2高表达患者中表现出显著疗效，但对于HER2低表达（如1+）的患者，ADC药物的有效率相对较低。铂类化疗在这些患者中仍具有一定的优... more
导语：在MIBC（肌肉浸润性膀胱癌）保膀胱治疗中，随着ADC（抗体偶联）药物的不断涌现，治疗策略正经历一场深刻的革新。而在制定检测策略时，将从体系架构、质控标准和临床决策这三个不同的维度展开深入思考。
分层检测体系建设
张瑞赟 教授：主张构建"必检+扩展"的动态检测体系：
基础层：常规免疫组化（CK5/6、CK20等）明确基底/管腔分型
核心层：基于ADC药物研发进展，将HER2（IHC 3+或FISH阳性）、Nectin-4纳入必检项目
探索层：对PD-L1 CPS评分、TROP2及FGFR3... more
导语：在膀胱癌治疗领域，尤其是肌层浸润性膀胱癌（MIBC）的保膀胱治疗中，首次电切的策略选择一直是临床实践中的关键问题。传统的 TMT（电切联合放化疗）治疗模式中，最大化电切（TURBT）被视为标准步骤，但随着治疗手段的不断进步，这一策略是否仍然最优？
最大化电切的适用性思考张瑞赟 教授：传统TMT模式的最大化电切策略需要辩证看待。在新辅助治疗和精准医疗背景下，首次电切的目的已从单纯切除肿瘤转向为综合治疗提供决策依据，需根据患者个体特征动态调整。
诊断性电切的病理价值张朋 教授：首次电切的核心使... more
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