EAU Guidelines on Non-Muscle-Invasive Urothelial Carcinoma of the Bladder, the 2011 Update
EAU Guidelines on Non-Muscle-Invasive Urothelial Carcinoma of the Bladder, the 2011 Update
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DOI：
10.1016/j.eururo.2011.03.017
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发表时间：
2011-06-01
期刊：
影响因子：
23.4
通讯作者：
Roupret, Morgan
中科院分区：
文献类型：
--
作者：
Babjuk, Marko;Oosterlinck, Willem;Roupret, Morgan
背景和目标：介绍2011年欧洲泌尿外科协会（EAU）关于非肌层浸润性膀胱癌（NMIBC）的指南。证据获取：对2004 - 2010年发表的关于NMIBC诊断和治疗的文献进行系统回顾。更新了以前的指南，并分配了证据等级（LE）和推荐等级（GR）。证据综合：分期为Ta，T1或原位癌（CIS）的肿瘤被归类为NMIBC。诊断依赖于膀胱镜检查和组织学评价，乳头状肿瘤通过经尿道切除术（TUR）或CIS通过多次膀胱活检获得。对于乳头状病变，完整的TUR对于患者的预后至关重要。如果初次切除不完全或检测到高级别或T1肿瘤，应在2-6 wk内进行第二次TUR。在乳头状肿瘤中，可使用评分系统和风险表估计个体患者的复发和进展风险。根据复发和进展将患者分为低、中、高风险组是推荐辅助治疗的关键。对于肿瘤复发和进展风险较低的患者，建议立即进行一次化疗。具有中度或高度复发风险和中度进展风险的患者应接受一次立即灌注化疗，然后接受至少1年的卡介苗（BCG）膀胱内免疫治疗或进一步灌注化疗。乳头状肿瘤与高风险的进展和CIS应接受膀胱内BCG 1年。Cybidazole可提供给最高风险的患者，它至少是在BCG失败的患者推荐。该指南的详细版本可从EAU网站（www.uroweb.org）获得。结论：这些简略的EAU指南提供了关于NMIBC诊断和治疗的最新信息，以纳入临床实践。(C)2011年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Context and objective: To present the 2011 European Association of Urology (EAU) guidelines on non-muscle-invasive bladder cancer (NMIBC).Evidence acquisition: Literature published between 2004 and 2010 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the level of evidence (LE) and grade of recommendation (GR) were assigned.Evidence synthesis: Tumours staged as Ta, T1, or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection (TUR) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TUR is essential for the patient's prognosis. Where the initial resection is incomplete or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk.In papillary tumours, the risks of both recurrence and progression may be estimated for individual patients using the scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups-separately for recurrence and progression-is pivotal to recommending adjuvant treatment. For patients with a low risk of tumour recurrence and progression, one immediate instillation of chemotherapy is recommended. Patients with an intermediate or high risk of recurrence and an intermediate risk of progression should receive one immediate instillation of chemotherapy followed by a minimum of 1 yr of bacillus Calmette-Guerin (BCG) intravesical immunotherapy or further instillations of chemotherapy. Papillary tumours with a high risk of progression and CIS should receive intravesical BCG for 1 yr.Cystectomy may be offered to the highest risk patients, and it is at least recommended in BCG failure patients. The long version of the guidelines is available from the EAU Web site (www.uroweb.org).Conclusions: These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice. (C) 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.