非肌层浸润性膀胱癌术后复发的危险因素及新型预测标志物研究进展

Research Progress on Risk Factors and Novel Predictive Biomarkers for Postoperative Recurrence of Non-Muscle Invasive Bladder Cancer

摘要: 膀胱癌是泌尿系统最常见的恶性肿瘤之一，依据浸润深度分为非肌层浸润性和肌层浸润性两类。非肌层浸润性膀胱癌术后复发率较高，能否准确识别复发相关危险因素，直接关系到随访策略的制定和患者预后的改善。传统上，肿瘤数目、大小、分期、分级及原位癌等临床病理指标构成了复发评估的主要依据，然而单一指标预测价值有限，且现有风险模型存在高估复发风险和校准度不足等缺陷。在此背景下，外周血炎症与营养相关指标因检测无创、操作便捷和成本低廉而受到关注，有望成为传统分层方法的有效补充，但其阈值标准化问题仍有待解决。与此同时，尿液及组织等来源的分子标志物在提高预测准确性方面展现出一定前景，然而目前多数研究缺乏大样本前瞻性验证，检测标准化和临床可行性仍是制约其转化应用的重要问题。本文就非肌层浸润性膀胱癌术后复发的危险因素及新型预测标志物作一综述，为临床及研究者提供参考。

Abstract: Bladder cancer is one of the most common malignant tumors of the urinary system, categorized into non-muscle-invasive and muscle-invasive types according to infiltration depth. Non-muscle-invasive bladder cancer has a relatively high postoperative recurrence rate, and accurate identification of recurrence-related risk factors is directly associated with the formulation of follow-up strategies and the improvement of patient prognosis. Traditionally, clinicopathological parameters such as tumor number, size, stage, grade, and carcinoma in situ have constituted the main basis for recurrence assessment; however, the predictive value of any single parameter is limited, and existing risk models are flawed by overestimation of recurrence risk and inadequate calibration. In this context, peripheral blood inflammatory and nutritional indicators have drawn attention due to their non-invasiveness, convenience, and low cost, and are expected to serve as effective supplements to traditional stratification methods, although standardization of their cut-off values remains to be resolved. Meanwhile, molecular markers derived from urine and tissue have shown promising potential for improving predictive accuracy, yet most current studies lack large-scale prospective validation, and assay standardization and clinical feasibility remain major obstacles to their translational application. This article reviews the risk factors and novel predictive biomarkers for postoperative recurrence of non-muscle-invasive bladder cancer, providing a reference for clinicians and researchers.