EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2013 Guidelines
EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2013 Guidelines
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DOI：
10.1016/j.eururo.2013.11.046
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发表时间：
2014-04-01
期刊：
影响因子：
23.4
通讯作者：
Sherif, Amir
中科院分区：
文献类型：
--
作者：
Witjes, J. Alfred;Comperat, Eva;Sherif, Amir
背景：欧洲泌尿外科协会（EAU）肌肉侵袭性和转移性膀胱癌（BCa）指南小组每年更新其指南。本更新摘要综合了2013年指南文件，重点介绍了最新进展。目的：为肌肉侵袭性BCa （MIBC）患者的诊断和治疗提供分级建议，并与证据水平相关联。证据获取：对于指南的每个部分，在几个数据库中进行了涵盖过去10年的全面文献检索、扫描、审查，并在小组内部和外部专家之间进行了讨论。最后的结果反映在所提出的建议中。证据综合：吸烟和与工作有关的致癌物仍然是BCa最重要的危险因素。计算机断层扫描（CT）和磁共振成像可用于分期，尽管CT优先用于肺部评估。开放性根治性膀胱切除术加扩大淋巴结清扫术（LND）仍然是治疗非mibc和T2-T4aN0M0 BCa失败的首选治疗方法。然而，对于消息灵通、精心选择和顺从的患者，多模式治疗可以作为一种选择，特别是如果不能选择膀胱切除术。在决定根治性膀胱切除术时，应考虑合并症，而不是年龄。应鼓励患者积极参与决策过程，除非有特定的禁忌症，否则应向所有患者提供大陆尿转移。对于适合的患者，应始终讨论以顺铂为基础的新辅助化疗，因为它可以提高总生存率。对于转移性疾病的患者，建议使用含顺铂的联合化疗。不适合用卡铂联合化疗或单药治疗。结论：2013年EAU肌肉侵袭性和转移性BCa指南更新总结旨在提高肌肉侵袭性或转移性BCa患者的护理质量和预后。患者总结：在本文中，我们更新了肌肉侵袭性和转移性膀胱癌的EAU指南。我们建议在根治性治疗之前进行化疗，膀胱切除是局限于膀胱的疾病的标准治疗方法。(C) 2013年欧洲泌尿外科协会。Elsevier b.v.版权所有。
Context: The European Association of Urology (EAU) guidelines panel on Muscle-invasive and Metastatic bladder cancer (BCa) updates its guidelines yearly. This updated summary provides a synthesis of the 2013 guidelines document, with emphasis on the latest developments.Objective: To provide graded recommendations on the diagnosis and treatment of patients with muscle-invasive BCa (MIBC), linked to a level of evidence.Evidence acquisition: For each section of the guidelines, comprehensive literature searches covering the past 10 yr in several databases were conducted, scanned, reviewed, and discussed both within the panel and with external experts. The final results are reflected in the recommendations provided.Evidence synthesis: Smoking and work-related carcinogens remain the most important risk factors for BCa. Computed tomography (CT) and magnetic resonance imaging can be used for staging, although CT is preferred for pulmonary evaluation. Open radical cystectomy with an extended lymph node dissection (LND) remains the treatment of choice for treatment failures in non-MIBC and T2-T4aN0M0 BCa. For well-informed, well-selected, and compliant patients, however, multimodality treatment could be offered as an alternative, especially if cystectomy is not an option. Comorbidity, not age, should be used when deciding on radical cystectomy. Patients should be encouraged to actively participate in the decision-making process, and a continent urinary diversion should be offered to all patients unless there are specific contraindications. For fit patients, cisplatinum-based neoadjuvant chemotherapy should always be discussed, since it improves overall survival. For patients with metastatic disease, cisplatin-containing combination chemotherapy is recommended. For unfit patients, carboplatin combination chemotherapy or single agents can be used.Conclusions: This 2013 EAU Muscle-invasive and Metastatic BCa guidelines updated summary aims to increase the quality of care and outcome for patients with muscleinvasive or metastatic BCa. Patient summary: In this paper we update the EAU guidelines on Muscle-invasive and Metastatic bladder cancer. We recommend that chemotherapy be administered before radical treatment and that bladder removal be the standard of care for disease confined to the bladder. (C) 2013 European Association of Urology. Published by Elsevier B. V. All rights reserved.