编者按：在2026年ASCO GU大会这一全球泌尿生殖肿瘤领域顶级学术盛会上，香港中文大学Jeremy Teoh（张源津）教授团队携膀胱癌整块切除术系列重磅研究成果亮相，凭借高级别循证证据成为NMIBC诊疗领域的焦点，为非肌层浸润性膀胱癌（non-muscle invasive bladder cancer，NMIBC）的治疗革新奠定了坚实的临床基础。NMIBC占膀胱癌新发病例的75%以上，经尿道膀胱肿瘤电切术（transurethral resection of bladder tumor，TURBT）长期以来是其经典一线诊疗术式，但传统分块切除的手术模式存在难以突破的固有缺陷。经尿道膀胱肿瘤整块切除术（en bloc resection of bladder tumor，ERBT）以完整切除、精准评估的核心优势，成为近年泌尿肿瘤领域的研究热点，而Jeremy Teoh教授团队的系列研究，正是推动该术式从技术创新走向临床规范化应用的核心循证支撑。

 

Jeremy Teoh张源津教授：传统TURBT采用分块切除的模式处理膀胱肿瘤，在长期临床实践中暴露出两大核心短板，也是导致NMIBC术后复发率居高不下的关键诱因：其一，分块切除会造成肿瘤组织碎裂，大量游离肿瘤细胞漂浮于膀胱内，极易引发肿瘤种植转移，直接导致术后早期疾病复发；其二，破碎的手术标本无法完成规范的病理切缘评估，难以精准判断肿瘤是否完整切除，不仅大幅升高手术床残留病灶的风险，还会影响病理分期的准确性与后续辅助治疗的临床决策。针对这一临床痛点，ERBT应运而生。该术式的核心治疗逻辑，是将肿瘤连同周围正常组织完整剥离切除，最大限度减少肿瘤细胞播散与种植风险，同时通过完整的手术标本实现精准的切缘病理评估，确保阴性切缘，真正达成肿瘤的根治性切除。这一理念，也成为我们团队系列研究贯穿始终的核心逻辑。

 

我扪中心牵头开展了全球首个多中心、随机、III期对照试验（EB-StaR研究，NCT02993211），该研究纳入香港13家临床中心、共350例肿瘤直径≤3cm的NMIBC患者，头对头对比了ERBT与传统TURBT的临床疗效与安全性，是该领域迄今级别最高的循证研究之一。

 

研究核心结果显示：在手术设备基本一致的前提下，ERBT组患者术后1年肿瘤复发率从传统TURBT组的38.1%显著降至28.5%，复发风险实现显著降低。亚组分析进一步证实，单发肿瘤、直径1~3cm的膀胱肿瘤、Ta期疾病及中危NMIBC患者，是ERBT的最大获益人群，复发控制优势尤为突出。

 

安全性层面，两组患者围手术期不良事件发生率无统计学差异，ERBT未增加出血、膀胱穿孔、闭孔神经反射等手术并发症风险，具备与传统术式相当的临床安全性。基于该研究的重磅结果，对于肿瘤直径＜3cm的膀胱肿瘤患者，应优先考虑采用ERBT的治疗策略。

 

Oncology Frontier:In recent years，ERBT has emerged as a novel surgical treatment for patients with NMIBC，and your team has completed a pivotal phase III clinical trial on this procedure.Could you introduce the clinical application of ERBT based on your research findings and clinical experience?

 

Professor Jeremy Teoh:Traditional TURBT manages bladder tumors via a piecemeal resection approach，which has two core shortcomings exposed in long-term clinical practice.These shortcomings are also the key drivers of the persistently high postoperative recurrence rate of NMIBC.First，piecemeal resection leads to fragmentation of tumor tissue，releasing large numbers of free tumor cells into the bladder lumen，which greatly increases the risk of tumor implantation and metastasis，directly causing early postoperative disease recurrence.Second，fragmented surgical specimens cannot support standardized pathological margin assessment，making it impossible to accurately determine whether the tumor has been completely resected.This not only drastically elevates the risk of residual lesions in the surgical bed，but also compromises the accuracy of pathological staging and clinical decision-making for subsequent adjuvant therapy.

 

In response to this unmet clinical need，ERBT came into being.The core therapeutic logic of this procedure is to completely dissect and resect the tumor en bloc together with the surrounding normal tissue，minimizing the risk of tumor cell dissemination and implantation.Meanwhile，intact surgical specimens enable accurate pathological evaluation of surgical margins to ensure negative margins，truly achieving radical resection of the tumor.This concept has also been the core logic running through the series of studies conducted by our team.

 

Our center led the world’s first multicenter，randomized，phase III controlled trial(the EB-StaR trial，NCT02993211).The study enrolled 350 patients with NMIBC and tumor diameter≤3 cm from 13 clinical centers in Hong Kong，with a head-to-head comparison of the clinical efficacy and safety between ERBT and traditional TURBT.To date，it remains one of the highest-level evidence-based studies in this field.

 

The core findings of the study showed that:with basically consistent surgical equipment，the 1-year postoperative tumor recurrence rate in the ERBT group was significantly reduced to 28.5%，compared with 38.1%in the traditional TURBT group，achieving a marked reduction in recurrence risk.Further subgroup analysis confirmed that patients with solitary tumor，bladder tumor 1-3 cm in diameter，Ta-stage disease，and intermediate-risk NMIBC were the populations who derived the greatest benefit from ERBT，with a particularly prominent advantage in recurrence control.

 

In terms of safety，there was no statistically significant difference in the incidence of perioperative adverse events(AEs)between the two groups.ERBT did not increase the risk of surgical complications including bleeding，bladder perforation，and obturator nerve reflex，presenting clinical safety comparable to the traditional procedure.Based on the landmark results of this study，ERBT should be prioritized as the treatment strategy for patients with bladder tumors<3 cm in diameter.

 

Jeremy Teoh张源津教授：为进一步优化高危NMIBC的全程治疗方案，团队对EB-StaR研究数据进行了事后分析，重点探索了ERBT与传统TURBT分别联合术后辅助卡介苗（BCG）膀胱灌注的预后差异，相关分析结果也在本次ASCO GU大会中重磅公布，为高危NMIBC患者的个体化治疗提供了关键临床依据。

 

数据显示，接受传统TURBT联合辅助BCG灌注的患者，术后1年复发率约为26.3%，且所有复发事件均集中在术后3~6个月的早期阶段。研究团队指出，这类早期复发并非由肿瘤本身的生物学特性驱动，而是源于分块切除带来的肿瘤残留、种植等手术技术缺陷——即便采用了BCG灌注进行肿瘤控制，也无法完全弥补手术切除不彻底带来的早期复发风险。

 

而在接受ERBT联合辅助BCG灌注的患者中，实现了“术中根治性肿瘤控制+术后BCG长期免疫控瘤”的协同效应。即便该亚组入组人群均为高危NMIBC患者，其术后1年复发率仅为5%，2年复发率也仅约10%，展现出极为优异的肿瘤控制效果。该研究结果进一步明确了NMIBC治疗的核心逻辑：通过更优质的根治性手术实现早期肿瘤控制，再辅以规范的辅助维持治疗，有望让绝大多数高危NMIBC患者获得更好的长期预后，甚至实现临床治愈。

 

Oncology Frontier:For patients after ERBT，your team has also conducted a phase III clinical trial of intravesical Bacillus Calmette-Guérin(BCG)therapy.Could you introduce the treatment strategies in this regard based on your research findings and clinical experience?

 

Professor Jeremy Teoh:To further optimize the full-course treatment regimen for high-risk NMIBC，our team performed a post-hoc analysis of the EB-StaR trial data，focusing on exploring the prognostic difference between ERBT and traditional TURBT when combined with postoperative adjuvant intravesical BCG instillation.The relevant analysis results were also presented at this ASCO GU meeting，providing key clinical evidence for individualized treatment of patients with high-risk NMIBC.

 

Data showed that patients receiving traditional TURBT plus adjuvant BCG instillation had a 1-year postoperative recurrence rate of approximately 26.3%，with all recurrence events concentrated in the early period of 3-6 months after surgery.Our team pointed out that such early recurrence was not driven by the intrinsic biological characteristics of the tumor itself，but by surgical technical defects including tumor residual and implantation caused by piecemeal resection—even BCG instillation for tumor control cannot completely offset the early recurrence risk caused by incomplete surgical resection.

 

In contrast，patients treated with ERBT plus adjuvant BCG instillation achieved a synergistic effect of intraoperative radical tumor control+long-term immune-mediated tumor suppression by postoperative BCG.Even though all patients enrolled in this subgroup had high-risk NMIBC，the 1-year postoperative recurrence rate was only 5%，and the 2-year recurrence rate was merely approximately 10%，demonstrating an extremely favorable tumor control effect.

 

The results of this study further clarified the core logic of NMIBC treatment:achieving early tumor control with high-quality radical surgery，supplemented by standardized adjuvant maintenance therapy，is expected to enable the vast majority of patients with high-risk NMIBC to obtain better long-term prognosis and even achieve clinical cure.

 

Jeremy Teoh张源津教授：传统手术器械并非为ERBT设计，操作难度高、学习曲线长的特点，一定程度上限制了该术式的全球临床推广。为此，我们团队联合香港中文大学工程学院，牵头开展了新型全柔性双臂内镜手术机器人首次人体试验（VIABLE试验），成功攻克了ERBT操作精准度不足、普及难度高的行业痛点，推动该术式进一步向精准化、微创化升级。

 

该新型机器人设备可通过常规26Fr膀胱镜通道，实现双器械协同操作，术者可通过操作台远程控制，同步完成肿瘤的精准牵拉与解剖性切开，大幅提升了整块切除的操作流畅度、精准度与适用范围，显著降低了膀胱穿孔等并发症的发生风险。

 

试验I期数据显示，研究共纳入6例患者、合计12个膀胱肿瘤，手术技术成功率达100%；所有患者的手术标本均完整获取逼尿肌组织，完全满足病理分期评估需求；所有NMIBC患者的手术标本均实现阴性切缘；且术后无≥2级的手术相关并发症发生，展现出极为优异的安全性与有效性。

 

目前，VIABLE试验的II期研究正在顺利推进，待研究完成后，该新型机器人设备有望获得全面的临床验证，惠及全球更多的膀胱癌患者，进一步推动ERBT技术的规范化普及与技术迭代。

 

Oncology Frontier:Robotic surgery has become a major innovation in the field of urology in recent years.Your team has launched the VIABLE trial of ERBT using a novel transurethral robotic platform.Could you introduce the important progress and future application potential of this study?

 

Professor Jeremy Teoh:Traditional surgical instruments are not designed for ERBT，and the procedure is characterized by high technical difficulty and a steep learning curve，which to a certain extent limits its global clinical popularization.For this reason，our team，in collaboration with the Faculty of Engineering of CUHK，led the first-in-human(FIH)trial of a novel fully flexible dual-arm endoscopic surgical robot(the VIABLE trial).This study has successfully addressed the industry pain points of insufficient operational accuracy and high popularization difficulty of ERBT，further driving the procedure to upgrade towards precision and minimal invasiveness.

 

This novel robotic device can realize dual-instrument collaborative operation through a conventional 26 French(Fr)cystoscope channel.The surgeon can perform remote control via the operating console to synchronously complete precise traction of the tumor and anatomical dissection，which greatly improves the operational fluency，accuracy and applicable range of en bloc resection，and significantly reduces the risk of complications such as bladder perforation.

 

The phase I data of the trial showed that the study enrolled 6 patients with a total of 12 bladder tumors，with a 100%surgical technical success rate.Detrusor muscle tissue was completely obtained in the surgical specimens of all patients，fully meeting the requirements for pathological staging assessment.All surgical specimens from patients with NMIBC achieved negative surgical margins.No grade≥2 surgery-related complications occurred postoperatively，demonstrating excellent safety and efficacy.

 

At present，the phase II study of the VIABLE trial is progressing smoothly.Upon completion of the study，this novel robotic device is expected to obtain comprehensive clinical validation，benefit more bladder cancer patients worldwide，and further promote the standardized popularization and technical iteration of ERBT.

Jeremy Teoh张源津教授：为进一步明确ERBT的长期临床价值，推动该技术在全球范围内的规范化推广，我们团队发起了全球膀胱肿瘤整块切除术登记研究（Global En Bloc Resection Registry），搭建了该领域首个全球性的真实世界研究平台。

 

截至目前，该登记研究已有全球超100家临床中心加入，累计入组患者已达3500例，研究最终目标入组5000例患者。该研究旨在通过大样本、多中心的真实世界数据，进一步完善ERBT的临床证据体系，明确不同特征人群的获益分层、长期疗效与安全性，最终让全球更多临床医生与膀胱癌患者，从这项革新性的术式中获益。

 

Oncology Frontier:Finally，could you introduce the important upcoming studies you are conducting in the field of ERBT?

 

Professor Jeremy Teoh:To further clarify the long-term clinical value of ERBT and promote the standardized global promotion of this technique，our team has launched the Global En Bloc Resection Registry，establishing the first global real-world research platform in this field.

 

Up to now，more than 100 clinical centers worldwide have joined the registry study，with a cumulative enrollment of 3500 patients，and the final enrollment target of the study is 5000 patients.The study aims to further improve the clinical evidence system of ERBT through large-sample，multicenter real-world data，clarify the benefit stratification，long-term efficacy and safety in populations with different clinical characteristics，and ultimately enable more clinicians and bladder cancer patients worldwide to benefit from this innovative procedure.

 

 

从2026 ASCO GU大会的重磅发布，到III期RCT的里程碑式循证证据，再到联合辅助治疗的方案优化、机器人技术的创新突破、全球真实世界研究的全面布局，Jeremy Teoh教授团队构建了完整的ERBT循证体系，彻底改写了NMIBC“单纯手术切除”的传统治疗模式。以“优质根治性手术+规范辅助治疗”为核心的全新治疗理念，正在成为NMIBC诊疗的新趋势，为更多膀胱癌患者带来了临床治愈的希望。