PDF(Pubmed)
Abstract：
Bladder cancer ranks among the most common cancers globally. At diagnosis, 75% of patients have non-muscle-invasive bladder cancer (NMIBC). Patients with low-risk NMIBC have a good prognosis, but recurrence and progression rates remain high in intermediate- and high-risk NMIBC, despite the decades-long availability of effective treatments for NMIBC such as intravesical Bacillus Calmette-Guérin (BCG). The present review provides an overview of NMIBC, including its burden and treatment options, and then reviews aspects that counteract the successful treatment of NMIBC, referred to as unmet treatment needs. The scale and reasons for each unmet need are described based on a comprehensive review of the literature, including insufficient adherence to treatment guidelines by physicians because of insufficient knowledge, training, or access to certain therapy options. Low rates of lifestyle changes and treatment completion by patients, due to BCG shortages or toxicities and adverse events as well as their impact on social activities, represent additional areas of potential improvement. Highly heterogeneous evidence for the effectiveness and safety of some treatments limits the comparability of results across studies. As a result, efforts are underway to standardize treatment schedules for BCG, but intravesical chemotherapy schedules remain unstandardized. In addition, risk-scoring models often perform unsatisfactorily due to significant differences between derivation and real-world cohorts. Reporting in clinical trials suffers from a lack of consistent outcomes reporting in bladder cancer clinical trials, paired with an under-representation of racial and ethnic minorities in many trials.
摘要：
膀胱癌是全球最常见的癌症之一。诊断时,75％的患者患有非肌层浸润性膀胱癌（NMIBC）。低危NMIBC患者预后良好,但中高危NMIBC的复发率和进展率仍然很高，尽管NMIBC已有数十年的有效治疗方法，例如膀胱内卡介苗（BCG）。本综述概述了NMIBC，包括其负担和治疗选择，然后回顾了抵消NMIBC成功治疗的方面，称为未满足的治疗需求。根据对文献的全面回顾，描述了每个未满足需求的规模和原因，包括由于知识不足，医生对治疗指南的坚持不足，培训,或获得某些治疗选择。患者生活方式改变和治疗完成率低，由于BCG短缺或毒性和不良事件及其对社会活动的影响，代表潜在改进的额外领域。某些治疗方法的有效性和安全性的高度异质性证据限制了研究结果的可比性。因此,正在努力使BCG的治疗时间表标准化，但膀胱内化疗方案仍未标准化。此外,由于推导和真实世界队列之间的显著差异,风险评分模型的性能通常不令人满意.临床试验中的报告在膀胱癌临床试验中缺乏一致的结果报告，在许多试验中，种族和少数民族的代表性不足。
