urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2022-10-4-155-164urovest-615Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWS ARTICLEЛабораторные предикторы ответа на внутрипузырную БЦЖ-терапию у пациентов с немышечно-инвазивным раком мочевого пузыряLaboratory predictors to intravesical BCG therapy response in patients with non-muscle invasive bladder cancerhttps://orcid.org/0000-0002-2311-134XКоняшкинаС. Ю.KonyashkinaS. Yu.

Коняшкина Светлана Юрьевна — врач-уролог онкологического отделения №6 (андрологии и онкоурологии) НИЦ урологии ПСПбГМУ им. акад. И.П. Павлова Минздрава России.

197022, Санкт-Петербург, ул. Льва Тостого, д. 6-8

Svetlana Yu. Konyashkina — M.D., Urologist, Oncology Division No.6 (Andrology and Oncological Urology), Research Centre of Urology, Pavlov First Saint Petersburg State Medical University.

6-8 Lev Tolstoy St., St. Petersburg, 197022

svetakonyashkina@gmail.comhttps://orcid.org/0000-0001-5183-5153РеваС. А.RevaS. A.

Рева Сергей Александрович — кандидат медицинских наук, заведующий онкологическим отделением №6 (андрологии и онкоурологии) НИЦ урологии ПСПбГМУ им. акад. И.П. Павлова Минздрава России.

197022, Санкт-Петербург, ул. Льва Тостого, д. 6-8

Sergey A. Reva — M.D., Cand.Sci.(Med), Head, Oncology Division No.6 (Andrology and Oncological Urology), Research Center of Urology, Pavlov First Saint Petersburg State Medical University.

6-8 Lev Tolstoy St., St. Petersburg, 197022

sgreva79@mail.ruhttps://orcid.org/0000-0003-3460-3427ПетровС. Б.PetrovS. B.

Петров Сергей Борисович — доктор медицинских наук, профессор, руководитель НИЦ урологии ПСПбГМУ им. акад. И.П. Павлова Минздрава России.

197022, Санкт-Петербург, ул. Льва Тостого, д. 6-8

Sergey B. Petrov — M.D., Dr.Sc.(Med), Full Prof., Head, Research Centre of Urology, Pavlov First Saint Petersburg State Medical University.

6-8 Lev Tolstoy St., St. Petersburg, 197022

petrov-uro@yandex.ruПервый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова Минздрава РоссииРоссияPavlov First St. Petersburg State Medical UniversityRussian Federation202226122022104155164Copyright © Коняшкина С.Ю., Рева С.А., Петров С.Б., 20232023Коняшкина С.Ю., Рева С.А., Петров С.Б.Konyashkina S.Y., Reva S.A., Petrov S.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/615Введение

Введение. Трансуретральная резекция (ТУР) является «золотым стандартом» лечения пациентов с немышечно-инвазивным раком мочевого пузыря (НМИРМП). Однако высокая частота развития рецидивов заболевания после оперативного лечения говорит не только о необходимости регулярного наблюдения с целью своевременного выявления рецидива опухоли, но также и о необходимости в ряде случаев проведения адъювантной противоопухолевой терапии, направленной на профилактику рецидива и прогрессирования заболевания. В связи с этим пациентам, относящимся к высокой и иногда промежуточной группам риска прогрессирования, в послеоперационном периоде показано проведение адъювантной внутрипузырной иммунотерапии БЦЖ. Несмотря на длительный опыт применения БЦЖ-вакцины в лечении НМИРМП, до сих пор остаётся открытым вопрос о существовании возможных прогностических маркеров и предикторов ответа на внутрипузырную БЦЖ-терапию.

Цель исследования

Цель исследования. Провести обзор существующих работ, посвящённых использованию различных маркеров в качестве предикторов ответа на внутрипузырную БЦЖ-терапию у пациентов с НМИРМП.

Материалы и методы

Материалы и методы. Используя термины «рак мочевого пузыря», «немышечно-инвазивный рак мочевого пузыря» в сочетании с «рецидив рака мочевого пузыря», «прогрессирование», «БЦЖ-терапия», «внутрипузырная терапия», «иммунный ответ», «молекулярные маркеры» мы провели поиск соответствующих статей в PubMed/Medline и Google Scholar, опубликованных в период с 2000 по 2022 годы.

Результаты

Результаты. Ведущими в прогнозировании ответа на внутрипузырную БЦЖ-терапию у пациентов с НМИРМП остаются клинико-патологические характеристики опухоли и самого пациента. Тем не менее, для повышения эффективности оценки риска развития неблагоприятных исходов рака мочевого пузыря (РМП) и выбора наиболее подходящей стратегии наблюдения и лечения в каждом конкретном случае необходимо внедрение дополнительных параметров оценки. В качестве таких параметров могли бы быть рассмотрены молекулярные и генетические маркеры, позволяющие выявить различия между опухолями на более глубоком уровне.

Заключение

Заключение. В настоящее время отсутствуют маркеры, имеющие высокую доказательность в прогнозировании ответа на внутрипузырную БЦЖ-терапию у пациентов с НМИРМП по сравнению с клинико-патологическими характеристиками опухоли и самого пациента. Лучшее понимание молекулярно-генетических путей патогенеза РМП, механизма противоопухолевого эффекта БЦЖ позволит осуществить выбор маркеров, обладающих наиболее высокой специфичностью в отношении РМП, что позволит повысить предиктивную способность существующих в настоящий момент инструментов оценки рисков развития рецидива РМП и его прогрессирования.

Introduction

Introduction. Transurethral resection of bladder tumor (TURBT) is the gold standard treatment for patients with non-muscle invasive bladder cancer (NMIBC). However, the high recurrence rate after TURBT makes necessary not only regular following to reveal recurrence disease timely, but it also talks about a necessity of adjuvant antitumor therapy in some cases, that allows to prevent disease recurrence and progression. In this regard, patients belonging to high- and sometimes intermediate- risk progression groups are shown to undergo postoperative adjuvant intravesical Bacillus Calmette–Guérin (BCG) therapy. Despite the long experience of using BCG therapy for NMIBC treatment the question of the existence of possible prognostic markers and response predictors to intravesical BCG therapy remains open.

Objective

Objective. To review cutting-edge data on different markers that can be used as predictive response markers to ongoing intravesical BCG therapy in NMIBC-patients.

Materials and methods

Materials and methods. A literature search was conducted using PubMed/ Medline and Google Scholar databases. We used terms 'bladder cancer', 'non-muscle-invasive bladder cancer' in conjunction with 'recurrence', 'progression', 'BCG', 'intravesical therapy', 'immune response', 'molecular markers' to choose relevant articles published between 2000 and 2022.

Results

Results. Clinical and pathological characteristics of the tumor and the patient himself remain leading in predicting the response to intravesical BCG therapy in NMIBC-patients. However, to improve the effectiveness of assessing the risk of developing adverse BC outcomes and choosing the most appropriate strategy for monitoring and treatment in each case, it is necessary to introduce additional assessment parameters. Molecular and genetic markers could be considered as such parameters, make it possible to reveal differences between tumors at a deeper level.

Conclusion

Conclusion. Currently, there are no markers that have high-evidence in predicting response to intravesical BCG therapy in NMIBC-patients compared with the cliniсal and pathological characteristics of the tumor and the patient himself. The clearer awareness of molecular genetic pathways of BC pathogenesis, the mechanism of BCG antitumor effect will make it possible to competently select markers that have the highest specificity for BC, which will increase the predictive ability of currently existing tools to assess the risks of BC recurrence and progression.

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The authors declare that there are no conflicts of interest present.