The term invasive bladder cancer is usually used to refer to bladder cancers with an infiltration depth of the muscularis propria of the bladder or above. According to the 2002 AJCC’s TNM staging which includes bladder tumors of stage T2-T4, about 20% of all bladder tumors diagnosed for the first time, and about 15%-20% of initially diagnosed non-muscular invasive bladder cancers will progress to invasive bladder cancer. Currently, the gold standard of treatment for MIBC is radical total cystectomy. However, radical total cystectomy still has several major problems: 1. The bladder is an organ responsible for storing and emptying urine, and no other human tissue or organ can replace its function. 2, Radical cystectomy is a major surgery with more complex techniques and more postoperative complications (perioperative mortality rate of 1.5%-4.2% and complication rate of 58%-67%), which are not tolerated by all patients. 3, regardless of the various diversion methods will be accompanied by a reduction in the quality of life (stoma care, regular urination, blood tests, etc.), and personal dignity is affected, so only when you lose the ability to urinate, you will miss the days when you could urinate normally. 4. Regardless of the technique used, the vast majority of patients after radical cystectomy affect sexual function. How can these problems be addressed? Reducing surgical trauma and overall comprehensive treatment are feasible methods! As the view that “tumor is a systemic disease” has been confirmed by more and more studies and understood by more and more people, the application of integrated treatment (surgery combined with radiotherapy, targeted therapy, immunotherapy, etc.) in MIBC is also increasing. Based on the above, integrated therapy with bladder preservation has also gradually begun to be applied to MIBC. The efficacy of applying a single treatment with bladder preservation to treat invasive bladder cancer is not ideal for either TURBT, radiotherapy or chemotherapy alone. If radical cystectomy is used, patients have an overall 5-year survival rate of 54.5% to 68% and a 10-year survival rate of 66%. But the cost is the loss of the bladder. Existing data show that the use of radiation and/or chemotherapy-based comprehensive treatment for this group of patients can not only preserve the bladder, but also the 5-year survival rate after treatment can reach 40% to 60%, with the benefit of preserving the bladder, improving the quality of life, and even if the tumor recurs there is still a chance of salvage surgery. There are two main modalities of comprehensive bladder preservation treatment: (1) Radical transurethral resection of bladder tumors (TURBt)-based combination of radiotherapy and/or chemotherapy; (2) Partial cystectomy-based combination of radiotherapy and/or chemotherapy. Radiotherapy and chemotherapy alone are not recommended. 1, radical TURBt combined with radiotherapy and (or) chemotherapy: At present, the use of this way of treatment is more mature in the United States and Europe, the common features are: (1) the first TURBT to maximize the resection of the tumor to clarify the stage; (2) the use of simultaneous radiotherapy and chemotherapy, chemotherapy programs are more often chosen to cisplatin (DDP) based on the combination of the program; (3) radiotherapy and chemotherapy, and then cystoscopy for evaluation of the therapeutic effects If the treatment is unsuccessful, radical cystectomy will be performed. A number of studies, including MGH, University of Paris, etc., found that the 5-year overall survival rate of MIBC with radical TURBt combined with cisplatin-based radiotherapy was 60%, which is similar to the gold standard, and the success rate of bladder preservation was close to 50%. Radical TURBt combined with chemotherapy or radical TURBt combined with radiotherapy is less effective than simultaneous combination of radiotherapy and chemotherapy, a study has observed the combined use of chemotherapy (regimen of MMC+5-FU) plus radiotherapy after radical TURBt, with postoperative adjuvant chemotherapy alone as the control group, and found that the 2-year local tumor recurrence-free survival rate of the former group was significantly higher than that of the control group (67% vs. 54%, P=0.03), and the two groups had significantly higher overall survival rates than the control group (P=0.03). 0.03), and there was no statistically significant difference in toxic side effects between the two groups. Comprehensive treatment based on partial cystectomy: Partial cystectomy was widely used in the treatment of MIBC in the 1950s. Compared with TUR, partial cystectomy has the advantages of being able to remove the tumor in its entirety and carry out lymph node dissection; and compared with radical total cystectomy, partial cystectomy has the advantages of being able to preserve the bladder function, having higher quality of life, and having lower surgical risks and complication rates. The overall prognosis of partial cystectomy alone is similar to that of radical total cystectomy. The advantages of partial cystectomy are preservation of normal bladder and normal voiding function, and in men, preservation of erectile function, better quality of life, shorter operative time, and fewer surgical complications and risks. The disadvantage is the high rate of local recurrence. Literature reports that the recurrence rate can reach 19-78%. Currently, radical TURBt-based comprehensive treatment is more popular internationally, and relatively little research has been done on partial cystectomy-based comprehensive treatment, and our team has done a little work in this area. Our study found that the 5-year survival rate of partial cystectomy combined with radiotherapy was similar to that of radical cystectomy cases. However, due to our wide inclusion criteria, the recurrence rate was higher at 60%. Problems with surgical indications Given the higher percentage of lymph node metastases in invasive bladder cancer, patients considered for bladder-preserving treatment need to be meticulously selected, with a comprehensive assessment of the nature of the tumor and the depth of infiltration, and the correct choice of bladder-preserving surgery, supplemented by postoperative radiation and chemotherapy, and with close postoperative follow-up. No method has been shown to achieve similar efficacy in tumor control as radical total cystectomy. Currently, bladder-sparing treatment for patients with invasive bladder cancer is only available to patients who are physically unable to tolerate radical surgery, or who volunteer to participate in a well-documented clinical trial, or who do not wish to undergo radical cystectomy after being fully informed of their condition. It is also indicated only for: single, primary, small tumors that are located in the bladder apex and/or anterior wall and away from the bladder neck, negative biopsies of the resection surface base and margins, clinical stage T2-3, except for a history of Tis and superficial tumors, and no associated upper urinary tract complications. less than 5% of MIBCs meet the above criteria. Summary Taken together with the current data, patients with MIBC undergoing comprehensive treatment with bladder preservation have a 5-year overall survival rate of 45%-73% and a 10-year overall survival rate of 29%-49%, which is similar to the long-term prognosis reported in the literature as the gold standard. Moreover, bladder preservation was achieved in more than 50% of these cases, which significantly improved the quality of life and reduced the risk of surgery and complications without compromising the prognosis. Although some patients may develop radiation cystitis, ureteritis, and gastrointestinal complications, the vast majority are mild and improve with symptomatic treatment. In addition, timely disease progression, as long as timely detection and immediate radical total cystectomy, does not affect the patient’s prognosis. Therefore, it can be concluded that radical cystectomy is still the gold standard in the treatment of MIBC, but comprehensive bladder-sparing therapy deserves a place in the treatment of MIBC. However, it should be noted that for patients with progressive bladder cancer, radical cystectomy + pelvic lymph node dissection + urinary diversion is still the gold standard of treatment. Adopting the treatment of bladder preservation will inevitably bear the risk of disease progression and metastasis, and the corresponding economic burden will be increased, so patients should be fully informed, synthesize the advantages and disadvantages, and make their own choices.