新辅助化疗 (NAC) 旨在消灭微转移疾病，已成为肌层侵袭性膀胱癌 (MIBC) 患者进行根治性膀胱切除术 (RC) 的标准疗法。这是基于随机对照试验显示 NAC 与仅进行 RC 相比可提供生存益处。预计在给予膀胱保留治疗方法之前进行 NAC 也会产生类似的生存益处，但探索此概念的 RTOG 8903 的 III 期研究报道结果为负面。然而，有一些重要的要注意的限制。首先，选择膀胱保留的患者人群的特点已经从老年、虚弱的非手术候选者转变为年轻、身体更健康的患者，他们也更容易耐受 NAC。近年来，系统化疗、免疫治疗、放射技术和支持性治疗也有了重要的进展。因此，重新考虑在 MIBC 患者进行膀胱保留治疗前进行 NAC 的作用显得非常必要。版权所有 © 2022 Elsevier Inc.。

Neoadjuvant chemotherapy (NAC), which aims to eliminate micrometastatic disease, has been established as the standard of care for patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC). This is based on randomized controlled trials showing a survival benefit of NAC prior to RC compared to RC alone. It was anticipated that a similar survival benefit would also be seen when NAC was given prior to bladder preserving approaches, but the e phase III RTOG 8903 study which explored this concept was reported to be a negative study. However, there are a number of important caveats to be considered. First, the profile of patients opting for bladder preservation has changed from the older, frailer non-surgical candidates, to now also include younger, fitter patients opting for bladder preservation and who are also more likely to tolerate NAC. In recent years, there have also been important advances in systemic chemotherapy, immunotherapy, radiation techniques, and supportive care. As such revisitng the role of NAC prior to bladder preserving approaches in MIBC appears warranted.Copyright © 2022 Elsevier Inc. All rights reserved.