膀胱癌（bladdercancer，BC）是男性泌尿生殖系统三大恶性肿瘤之一，具有较高的发病率和死亡率，主要包括肌层浸润性膀胱癌（muscle-invasive bladder cancer, MIBC）和非肌层浸润性膀胱癌（non-muscle-invasive bladder cancer，NMIBC）。诊断BC的金标准为膀胱镜检查结合病理活检，此外还包括尿液细胞学检查和影像学检查。MIBC和NMIBC的治疗及预后因其组织病理学特征的不同而呈现出极大的差异。近年来MIBC的临床进展主要集中在新辅助免疫治疗与新辅助化疗联合免疫治疗、根治性膀胱切除术中淋巴结清扫术的范围、转移性BC的治疗进展等3方面，NMIBC的临床进展则重点关注TaT1期肿瘤和原位癌的管理，本文主要就目前BC的诊断方法及治疗手段进行归纳、总结，并展望其未来在更精确诊疗策略上的潜力和发展方向。

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任翔,曾晓勇.2024年膀胱癌诊治进展[J].泌尿外科杂志(电子版),2025,17(1):22-30.DOI:10.20020/j.CNKI.1674-7410.2025.01.04

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膀胱癌（bladder cancer，BC）是泌尿生殖系统肿瘤中最常见的恶性肿瘤之一，发病率和死亡率均位居恶性肿瘤前列，严重威胁公共卫生安全。根据GLOBOCAN 2020的数据，2020年全球新发BC病例为573000例，死亡人数为213000人，全球5年患病率为1721000例。膀胱癌的新发病例中，超过3/4发生在男性，男女的年龄标准化发病率（每10万人的比例）因地区不同而异，通常为6∶1至2∶1不等^[1-2]。研究表明，BC是我国泌尿系统肿瘤中新发病例和死亡病例最多的类型^[3]。BC的发病率差异与多种因素密切相关，包括烟草的使用、职业性暴露于芳香胺类化学物质、饮用水中砷含量等环境因素。此外，接受盆腔放疗、使用环磷酰胺等化疗药物或经历慢性尿路刺激的患者，亦可能增加患病风险，形成医源性BC^[4-5]。尽管近年来BC的研究与治疗不断进步，但在其诊治过程中仍面临诸多挑战。改善早期诊断能力及拓展新的治疗选择，对于提高BC的早期发现和预后改善至关重要。随着2024年BC诊疗领域的新进展，本文将对当前BC的诊断和治疗进行述评。

1 BC 的分型

2 BC 的诊断

2.1 膀胱镜检查

2.2 尿液细胞学检查

2.3 生物标志物与分子诊断

2.4 影像学检查

3 BC 的治疗

3.1 TURBT 和整块膀胱肿瘤切除术

3.2 NMIBC的膀胱内灌注化疗

3.3 根治性膀胱切除术

3.4 三联疗法

3.5 围手术期系统治疗

3.6 转移性膀胱癌的系统性治疗

4 总结

2024年，BC的诊疗取得了显著进展，尤其是在免疫治疗方面。免疫检查点抑制剂（如PD-1和PD-L1抑制剂）正逐步成为MIBC新辅助或转移性BC一线治疗的标准选择，尤其对于无法耐受顺铂的患者。此外，抗体-药物偶联物联合免疫检查点抑制剂的实施也提高了转移性BC的临床前景。目前，许多新型试验纳入了免疫检查点抑制剂，在减少NMIBC的复发和进展方面均初步取得了有希望的结果。总的来说，BC的治疗前景在精准医疗和免疫治疗的推动下更加光明。

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