Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline
Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline
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DOI：
10.1016/j.juro.2016.06.049
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发表时间：
2016-10-01
影响因子：
6.6
通讯作者：
McKiernan, James M.
中科院分区：
文献类型：
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作者：
Chang, Sam S.;Boorjian, Stephen A.;McKiernan, James M.
目的：非肌肉浸润性膀胱癌（NMIBC）的异质性影响患者的复发率和进展率，尽管与总体有利的生存率相关。风险分层应影响评估、治疗和监测。本指南试图为NMIBC的管理提供一个临床框架。材料和方法：系统回顾利用了医疗保健研究和质量机构（AHRQ）的研究以及作者和顾问方法学家的补充。基于证据的陈述基于证据体强度等级A、B或C，并被指定为强、中等和有条件的建议，并以临床原则或专家意见的形式提出额外的陈述。1结果：风险分层方法将患者分为低、中、高风险三大类。重要的是，评估和治疗算法考虑了肿瘤特征，并独特地考虑了患者对治疗的反应。38个陈述的证据水平不同，但没有一个是A级证据，许多是c级证据。结论：NMIBC的护理强度和范围应集中在患者、疾病和治疗反应特征上。本指南试图提高临床医生评估和治疗每位患者的能力，但在未来的试验中，更高质量的证据对于提高对这些患者的护理水平至关重要。
Purpose: Although associated with an overall favorable survival rate, the heterogeneity of non-muscle invasive bladder cancer (NMIBC) affects patients' rates of recurrence and progression. Risk stratification should influence evaluation, treatment and surveillance. This guideline attempts to provide a clinical framework for the management of NMIBC.Materials and Methods: A systematic review utilized research from the Agency for Healthcare Research and Quality (AHRQ) and additional supplementation by the authors and consultant methodologists. Evidence-based statements were based on body of evidence strength Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions. 1Results: A risk-stratified approach categorizes patients into broad groups of low-, intermediate-, and high-risk. Importantly, the evaluation and treatment algorithm takes into account tumor characteristics and uniquely considers a patient's response to therapy. The 38 statements vary in level of evidence, but none include Grade A evidence, and many were Grade C.Conclusion: The intensity and scope of care for NMIBC should focus on patient, disease, and treatment response characteristics. This guideline attempts to improve a clinician's ability to evaluate and treat each patient, but higher quality evidence in future trials will be essential to improve level of care for these patients.