Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic.
Eur Urol. 2011 Jun;59(6):997-1008. doi: 10.1016/j.eururo.2011.03.017. Epub 2011 Mar 22.
To present the 2011 European Association of Urology (EAU) guidelines on non-muscle-invasive bladder cancer (NMIBC).
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.
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-Guérin (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).
These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.
介绍 2011 年欧洲泌尿外科学会（EAU）非肌肉浸润性膀胱癌（NMIBC）指南。
系统回顾了 2004 年至 2010 年间发表的关于 NMIBC 诊断和治疗的文献。更新了以前的指南，并分配了证据水平（LE）和推荐等级（GR）。
T a 、T 1 或原位癌（CIS）分期的肿瘤被归类为 NMIBC。诊断取决于膀胱镜检查和经尿道切除（TUR）获得的组织的组织学评估，在乳头状病变中，完全 TUR 对于患者的预后至关重要。如果初始切除不完全或发现高级别或 T1 肿瘤，则应在 2-6 周内进行第二次 TUR。在乳头状肿瘤中，使用评分系统和风险表可以为个体患者估计复发和进展的风险。将患者分层为低、中、高危组-分别用于复发和进展-对于推荐辅助治疗至关重要。对于肿瘤复发和进展风险低的患者，建议立即进行一次化疗灌注。复发风险中等或高、进展风险中等的患者应接受一次立即化疗灌注，然后至少接受 1 年的卡介苗（BCG）膀胱内免疫治疗或进一步的化疗灌注。具有高进展风险的乳头状肿瘤和 CIS 应接受 1 年的膀胱内 BCG 治疗。对于最高风险的患者可以提供膀胱切除术，对于 BCG 治疗失败的患者至少推荐该治疗方法。指南的长版本可在 EAU 网站（www.uroweb.org）上获得。
这些缩写的 EAU 指南提供了关于 NMIBC 诊断和治疗的最新信息，可纳入临床实践。
