EAU Guidelines on Non-Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2013
EAU Guidelines on Non-Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2013
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DOI：
10.1016/j.eururo.2013.06.003
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发表时间：
2013-10-01
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;Burger, Maximilian;Roupret, Morgan
背景：第一个欧洲泌尿外科协会（EAU）关于膀胱癌的指南于2002年出版[1]。目的：介绍2013年EAU关于非肌层浸润性膀胱癌（NMIBC）的指南。证据获取：对2010 - 2012年发表的关于NMIBC诊断和治疗的文献进行系统综述。对以前的指南进行了更新，并对证据等级和推荐等级进行了分配。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。在乳头状病变中，完整的TUR对患者的预后至关重要。如果初次切除不完全，标本中没有肌肉，或者检测到高级别或T1肿瘤，则应在2-6周内进行第二次TUR。可以使用EORTC评分系统和风险表估计个体患者的复发和进展风险。将患者分为低、中、高风险组是推荐辅助治疗的关键。对于低风险肿瘤患者，建议立即进行一次化疗。中危肿瘤患者应接受一次立即灌注化疗，随后接受1年全剂量卡介苗（BCG）膀胱内免疫治疗或进一步灌注化疗，最长1年。在高危肿瘤患者中，需要进行1-3年的全剂量膀胱内BCG。在肿瘤进展风险最高的患者中，应考虑立即进行根治性化疗。推荐在BCG难治性肿瘤中使用环磷酰胺。该指南的详细版本可从EAU网站获得：http://www.uroweb.org/guidelines/.Conclusions：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。患者摘要：EAU非肌肉浸润性膀胱癌小组发布了其指南的更新版本。目前的临床研究支持将患者分为不同的风险组;低风险、中等风险和高风险。这些风险组表明在初始治疗（内窥镜切除术）后发展为新的（复发性）癌症或进展为更具侵袭性（肌肉浸润性）膀胱癌的可能性，并且对于决定提供化疗或免疫治疗（膀胱安装）是最重要的。手术切除膀胱（根治性膀胱切除术）应仅在化疗或免疫治疗失败的患者中考虑，或在进展的最高风险组中考虑。(C)2013年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Context: The first European Association of Urology (EAU) guidelines on bladder cancer were published in 2002 [1]. Since then, the guidelines have been continuously updated.Objective: To present the 2013 EAU guidelines on non-muscle-invasive bladder cancer (NMIBC).Evidence acquisition: Literature published between 2010 and 2012 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the levels of evidence and grades of recommendation 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, where there is no muscle in the specimen, or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk. The risks of both recurrence and progression may be estimated for individual patients using the EORTC scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups is pivotal to recommending adjuvant treatment. For patients with a low-risk tumour, one immediate instillation of chemotherapy is recommended. Patients with an intermediate-risk tumour should receive one immediate instillation of chemotherapy followed by 1 yr of full-dose bacillus Calmette-Guerin (BCG) intravesical immunotherapy or by further instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. In patients at highest risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is recommended in BCG-refractory tumours. The long version of the guidelines is available from the EAU Web site: http://www.uroweb.org/guidelines/.Conclusions: These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.Patient summary: The EAU Panel on Non-muscle Invasive Bladder Cancer released an updated version of their guidelines. Current clinical studies support patient selection into different risk groups; low, intermediate and high risk. These risk groups indicate the likelihood of the development of a new (recurrent) cancer after initial treatment (endoscopic resection) or progression to more aggressive (muscle-invasive) bladder cancer and are most important for the decision to provide chemo-or immunotherapy (bladder installations). Surgical removal of the bladder (radical cystectomy) should only be considered in patients who have failed chemo-or immunotherapy, or who are in the highest risk group for progression. (C) 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.