Improving the outcome for invasive bladder cancer: the debate regarding pelvic lymphadenectomy moves from if to how.

摘要

The prognosis from invasive bladder cancer (BCa) has changed little over the last 30 yr [1]. Disease-specific survival remains around 50%, and it appears BCa is at risk of falling behind other solid malignancies. During the last 15 yr, for example, stage for stage improvements in the survival from breast cancer have averaged 1% per annum and are now around 30% better [2]. Improvements in the outcome of invasive BCa will probably occur from a better understanding of the disease, from a more rational approach to its detection and treatment, and from multimodal therapy. The latter needs to be developed through well-constructed clinical trials and requires the collaboration seen during the development of intravesical therapies. The likelihood of a specific (molecular) therapy to dramatically improve survival in BCa is small, given that the disease is characterized by numerous genetic and epige-netic alterations and the lack of familial syndromes [3].