摘要
膀胱的治疗效应多种多样，从经尿道切除后的局部改变到全身治疗后的广泛效应不等。国际泌尿病理学会（ISUP）于 2025 年 9 月在奥地利维也纳组织了一场共识会议，聚焦前列腺和膀胱治疗效应的评估。第 2 工作组负责膀胱专题，成员包括病理医生和临床医生。
工作组协作制定了一份面向 ISUP 会员、含 30 个问题的会前调查，涵盖以下主题：全身治疗相关改变、膀胱内治疗及放射治疗相关改变、治疗后膀胱标本的大体检查与报告，以及针对肉眼残留和/或微小残留病变的相关辅助检测方法。会前调查结果突出反映了对肿瘤退缩分级（TRG）的不确定性、切除术后及膀胱内治疗后病例报告实践的差异，以及对分子检测潜在用途的不同意见。
基于这些汇集的实践经验，工作组检索了原始医学文献，研究会前调查中存在争议的主题，为共识会议参与者整理了聚焦已发表经验的专题报告，并完善了供投票的共识问题。19 项投票陈述中有 18 项达成共识。使用分子检测区分良性模拟病变与癌这一项未达成共识。
总体而言，调查与现场共识投票支持对治疗后病例采用标准化的报告实践和术语、以跨学科协作方式建立膀胱肿瘤退缩分级方案，并支持在治疗后情境中使用选定的分子及免疫组织化学检测。
Abstract
Treatment effects in the urinary bladder are variable and range from localized post-transurethral resection changes to widespread systemic therapy effects. The International Society of Urological Pathology (ISUP) organized a consensus meeting in Vienna, Austria, in September 2025, focused on the evaluation of treatment effects in both the prostate and bladder. Working Group 2 was assigned the topic of the urinary bladder, and a group of pathologists and clinicians was convened. They worked cooperatively to develop a 30-question, premeeting survey for the ISUP membership, which covered the following topics: systemic therapy-related changes, intravesical therapy and radiotherapy-related changes, macroscopic examination and reporting of treated bladder specimens, and relevant ancillary testing methods for grossly residual and/or minimal residual disease. The premeeting survey results highlighted uncertainty about tumor regression grading (TRG), variability in reporting practices for post-resection and intravesical therapy cases, and divergent opinions on the potential utility of molecular testing. Based on findings from this crowd-sourced experience, the Working Group researched the primary medical literature to study the problematic premeeting survey topics, curated focused presentations of published experience for the consensus meeting participants and developed refined consensus questions for consensus voting. Consensus was achieved in 18/19 polling statements. Use of molecular tests to distinguish benign mimickers from carcinoma did not reach consensus. Overall, the surveys and in-person consensus voting supported standardized reporting practices and terminology for post-therapy cases, interdisciplinary development of a bladder TRG scheme, and the utility of select molecular and immunohistochemical testing in the post-treatment setting.