编者按：免疫治疗近几年来迅速发展，在晚期膀胱癌领域中取得了显著的临床效果：随着临床研究的不断深入，免疫治疗的应用探索逐步从晚期向局部晚期，围术期甚至疾病更早阶段覆盖，以度伐利尤单抗等为代表的免疫治疗将有望改写膀胱癌治疗现状。在今年的欧洲肿瘤内科学会年会（ESMO 2025）上，肿瘤瞭望-泌尿时讯特邀中国香港大学玛丽医院癌症医学中心李祖颖教授分享围手术期免疫治疗模式价值及其对患者生活质量的影响，多学科合作及未来发展方向等精彩内容。

 

李祖颖教授：我认为，今年是肌层浸润性膀胱癌围手术期治疗非常激动人心的一年。长久以来，标准治疗方案一直是在实施膀胱切除术前进行顺铂化疗的策略。该方案虽然能够使许多患者在初始阶段获得良好的缓解情况，但遗憾的是，即便历经如此高强度的治疗，仍有相当比例的患者面临肿瘤复发的风险。

 

值得欣喜的是，随着免疫疗法的引入，为这一领域注入了新的活力。如，NIAGARA方案中将抗PD-L1抗体度伐利尤单抗应用于术前新辅助治疗与术后辅助治疗，同时联合传统的顺铂基础化疗以改善患者的临床疗效。研究数据表明，这一组合疗法成效显著，不仅有效延长了患者的无事件生存期，更带来了明显的总生存期获益。

 

△NIAGARA研究的EFS分析

 

△NIAGARA研究pCR亚组和non-pCR亚组的OS分析

 

从作用机制来看，我认为在手术前、肿瘤尚保持完整状态时开展免疫治疗，能够精准激活并系统训练患者自身的免疫系统，赋予其主动识别及精准打击癌细胞的能力。而术后持续使用度伐利尤单抗，则进一步巩固和强化了这种特异性的抗癌免疫应答。基于现有证据，这种围术期治疗策略展现出强大的协同效应，有望为患者带来更为理想的治疗效果。

 

Oncology Frontier-UroStream：From ASCO to ESMO，we’ve seen a surge of exciting new data in bladder cancer.The NIAGARA regimen is drawing great attention in the MIBC field.How do you perceive the paradigm shift from conventional neoadjuvant chemotherapy to perioperative immunotherapy-based treatment?

 

Dr.Bryan li：I think this year is a very exciting year for treatment of muscle-invasive bladder cancer in the perioperative setting.Traditionally，our standard approach has been giving powerful cisplatin chemotherapy before removing the bladder(cystectomy).Many patients respond well initially，however，there is a significant proportion of patients that do recur after such very intensive therapy.

 

However，with the new incorporation of immunotherapy，for example，this time with a NIAGARA regimen，giving an anti-PD-L1 antibody，durvalumab，in the preoperative neoadjuvant as well as the adjuvant setting，together with a cisplatin-based chemotherapy.In fact，actually it helped patients to improve the progression-free survival as well as a very meaningful overall survival benefit.

 

I think，giving immunotherapy before operating—while the tumor is still intact—helps us’prime’or educate the patient’s own immune system to recognize and attack those cancer cells proactively.Then，continuing with post-surgery doses of durvalumab reinforces and locks in that anti-cancer response.In my view，this powerful combination truly translates into excellent outcomes for our patients.

 

△EFS Analysis of the NIAGARA Study

 

△OS analysis of the pCR and non-pCR subgroups in the NIAGARA study

 

李祖颖教授：在肿瘤治疗领域，患者的生活质量始终是核心考量因素之一，特别是在以手术为主要干预手段的“治愈”模式。因此，评估额外使用某种药物是否会产生损害生活质量的副作用具有至关重要的意义。我们很高兴地看到，临床研究数据显示，在化疗联合度伐利尤单抗的治疗中，未发现该方案对患者的健康相关生活质量产生任何负面影响。这一结果体现了其临床应用价值——我们不仅实现了患者生存率的提升和手术疗效的优化，更在保证治疗效果的同时完整保留了患者的生活质量。此类兼顾疗效与生活质量的治疗模式，无疑是肿瘤学界值得肯定的重要进展。

 

Oncology Frontier-UroStream：At this congress，health-related quality of life(HRQoL)outcomes from the NIAGARA trial evaluating perioperative durvalumab(D)plus neoadjuvant chemotherapy(NAC)in patients with muscle-invasive bladder cancer(MIBC)were presented.How do you interpret the impact of these data on current clinical practice?

 

Dr.Bryan li：I think，patient quality of life during treatment has always been absolutely crucial–especially in this curative setting around surgery.So whether additional of a drug would cause a detrimental，harmful effect to the quality of life is actually very important.And we are happy to see that with a combination of chemotherapy plus immunotherapy，durvalumab，we didn’t see any detrimental health-related quality of life effect，impact on the patient.So we are in a way，improving the patient’s survival，surgical outcome without causing at the without the cost of the patient’s impaired quality of life.And I think this is very reassuring for the for us in the community of oncology.

 

李祖颖教授：目前针对MIBC患者的全身治疗方案已取得多项进展，我们中心也积极推行多学科协作模式，汇聚了肿瘤内科、泌尿外科以及放射肿瘤科医生等专业力量，形成了紧密合作的医疗团队。

 

临床实践过程中，对于未来可能需要进行手术的患者，我们会组织多学科团队进行术前讨论。若患者存在实施全身治疗（涵盖化疗或免疫治疗等）的需求，该团队将负责患者的全程管理，包括密切监测病情变化、精准把控治疗进程，并及时处理可能出现的各类潜在副作用。

 

通过这种高效的团队合作机制，我们能够安全、规范地将各类新型全身治疗方案应用于临床实践。更为重要的是，临床数据显示，这种多学科协作下的综合治疗模式，不仅有效保障了治疗的安全性，还显著改善了患者的手术预后。

 

 

Oncology Frontier-UroStream：Because multidisciplinary coordination is so critical，could you share how muscle-invasive bladder cancer(MIBC)patients are managed in your center?What’s the referral flow between urology and medical oncology?

 

Dr.Bryan li：I think nowadays with the advances of the systemic therapy options in patients with muscle-invasive bladder cancer，in our center，we adopted a multi-disciplinary approach where we medical oncologists are working very closely together with surgeons，urologists，as well as radiation oncologists.So we will discuss all the patients before the operation and if the patient needs any systemic therapy，including chemotherapy or immunotherapy，we’ll be the one who’s mainly delivering it because we will be monitoring the patient’s closely and manage any potential side effects.

 

And in fact，when we are when we’re working as a team，we found that all of these newer systemic therapy options can be very safely delivered to patients and the surgical outcomes in indeed can improve also.

 

 

李祖颖教授：今年ESMO等学术大会，我们看到了一系列非常令人兴奋的临床试验。在我看来，未来有两个趋势尤为突出：

 

1.我们非常确信免疫疗法将彻底改变膀胱癌患者的治疗，从后线、到二线，以及一线治疗，甚至包括围手术期和新辅助治疗，免疫治疗已经覆盖了膀胱癌的全程管理。

 

2.我认为随着抗体偶联药物临床试验的更新，膀胱癌的治疗正变得越来越个性化。本次ESMO大会上，我们看到了针对不同靶点的治疗药物及临床研究数据，它们均显示出极具潜力的临床价值。未来的主要挑战之一在于如何筛选患者。如果患者符合多种潜在治疗方案的条件，我们如何才能最好地筛选和安排这些患者的治疗顺序？这些问题仍有待解答。

 

Oncology Frontier-UroStream：This year’s ESMO meeting has released a wealth of new and exciting data in the field of bladder cancer，including advances in immunotherapy，antibody–drug conjugates(ADCs)，and targeted therapies.How do you see these emerging findings shaping the future treatment landscape of bladder cancer?In your opinion，what are the main directions and remaining challenges for the next stage of bladder cancer management?

 

Dr.Bryan li：I think this year we see a really exciting bunch of trials coming up.From my perspective，two major trends stand out.

 

One is that we are very reassuring that immunotherapy is going to be the game changer in management of bladder cancer patients all the way from the refractory second and third line setting to the front line setting and even in the perioperative neoadjuvant adjuvant setting.Its impact spans every stage now.

 

And the second one is，I think the management of bladder cancer is getting to be more and more personalized with the newer read out of trials from the antibody-drug conjugates.We see different targets and they all very showing promising results.

 

I think in the future，the main challenge is really how do we select patients.If patients are eligible for multiple potential regimens，how do we best select and sequence these patients?These questions remained to be answered.

 

李祖颖教授

香港大学内外全科医学士（MBBS）、英国皇家内科医学院院士（MRCP）、香港医学专科学院院士（FHKAM）

李医生于2004年毕业于香港大学医学院。他在玛丽医院的内科完成了基础和高级医生培训。2012年，在完成高级内科和缓和医学的专科培训后，他被接纳为内科专科医生。随后，李医生在葛量洪医院的缓和医学科担任住院专科医生和副顾问医生。在此期间，他还担任医学伦理与人文学科的名誉临床助理教授，参与医学学生的教学和辅导。从2018年开始，李医生在玛丽医院接受了肿瘤内科专科培训，并于2020年被认证为肿瘤内科专科医生。

李医生专注于泌尿生殖系统和妇科癌症的治疗。他的研究兴趣包括新型癌症治疗的临床试验和转化研究。此外，他还参与医学院本科学生的癌症医学教学。

李医生也是多个专业机构的成员，包括香港内科医学院（HKCP）的肿瘤内科专业委员会和香港老年肿瘤学会。