范顺成,李福来,孙青风

肌层浸润性膀胱癌（MIBC）约占膀胱癌病例的30%，传统治疗疗效有限，保膀胱治疗成为研究热点。精准筛选患者是保膀胱治疗成功的关键，理想候选者通常为临床分期≤cT2、单发肿瘤直径<5 cm、完全切除且无肾积水或广泛原位癌者。单一疗法如TURBT、放疗或部分膀胱切除术疗效有限，易出现进展或复发。三联保膀胱治疗（TMT），即最大程度TURBT联合同步放化疗，可实现75%-83%的完全缓解率，疗效与根治性膀胱切除术相当，尤其适用于cT2期患者。近年来，免疫检查点抑制剂（ICIs）和抗体偶联药物（ADC）的应用显著提升了新辅助治疗效果，如EV联合帕博利珠单抗可使病理完全缓解率超过60%。未来方向包括分子分型指导个体化治疗、ctDNA动态监测、多学科协作及人工智能辅助诊疗，推动保膀胱治疗向更精准、高效的方向发展。

肌层浸润性膀胱癌；保留膀胱治疗；三联疗法；免疫检查点抑制剂；抗偶联药物

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