Bladder cancer (BC) possesses distinct molecular profiles that influence progression depending on its biological nature and delivered treatment intensity. Muscle-invasive BC (MIBC) and non-MIBC (NMIBC) demonstrate great intrinsic heterogeneity regarding different prognoses, survival, progression, and treatment outcomes. Transurethral resection of bladder tumor (TURBT) is the standard of care in treating NMIBC and serves both diagnostic and therapeutic purposes despite the prevalent recurrence and progression among many patients. In particular, flat urothelial carcinoma in situ and urothelial carcinoma with lamina propria invasion are the major precursors of MIBC. A new-generation photosensitizer, 5-Aminolevulinic acid (5-ALA), demonstrates high tumor specificity by illuminating the tumor lesion with a specific wavelength of light to produce fluorescence and has been studied for photodynamic diagnosis to detect precise tumor areas by TURBT. Additionally, it has been applied for treatment by producing its cytotoxic reactive oxygen species, as well as screening for urological carcinomas by excreting porphyrin in the blood and urine. Moreover, 5-ALA may contribute to screening before and after TURBT in NMIBC. Here, we summarize the updated evidence and ongoing research on photodynamic technology for NMIBC, providing insight into the potential for improving patient outcomes.
膀胱癌具有独特的分子特征，其进展受生物学特性及治疗强度影响。肌层浸润性膀胱癌与非肌层浸润性膀胱癌在预后、生存率、进展及治疗结局方面存在显著内在异质性。经尿道膀胱肿瘤切除术是治疗非肌层浸润性膀胱癌的标准方案，兼具诊断与治疗双重功能，但患者普遍存在复发与进展风险。其中平坦型尿路上皮原位癌及固有层浸润性尿路上皮癌是肌层浸润性膀胱癌的主要前驱病变。新一代光敏剂5-氨基酮戊酸通过特定波长光照激发肿瘤病灶产生荧光，展现出高肿瘤特异性，目前已应用于经尿道膀胱肿瘤切除术中的光动力诊断以实现精准肿瘤定位。此外，该药物通过产生细胞毒性活性氧应用于治疗领域，并通过血液和尿液中原卟啉排泄实现泌尿系统肿瘤筛查。在非肌层浸润性膀胱癌中，5-氨基酮戊酸还可用于经尿道膀胱肿瘤切除术前后的筛查。本文综述了光动力技术应用于非肌层浸润性膀胱癌的最新证据与研究进展，为改善患者预后提供新的视角。
Photodynamic Diagnosis and Therapy in Non-Muscle-Invasive Bladder Cancer
肿瘤(癌症)患者之家