Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Böhle A, Palou-Redorta J, Rouprêt M
Servicio de Urología, Hospital Motol, Segunda Facultad de Medicina, Universidad Carolina, Praga, República Checa.
Actas Urol Esp. 2012 Jul-Aug;36(7):389-402. doi: 10.1016/j.acuro.2011.12.001. Epub 2012 Mar 2.
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 and grade of recommendation 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.
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）关于非肌层浸润性膀胱癌（NMIBC）的指南。
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。对先前的指南进行了更新，并确定了证据水平和推荐等级。
分期为Ta、T1或原位癌（CIS）的肿瘤归为NMIBC。诊断依赖于膀胱镜检查以及对经尿道切除术（TUR）获取的乳头状肿瘤组织或对CIS进行的多次膀胱活检组织的组织学评估。对于乳头状病变，完整的TUR对患者的预后至关重要。如果初次切除不完整或检测到高级别或T1肿瘤，应在2 - 6周内进行二次TUR。对于乳头状肿瘤，可使用评分系统和风险表为个体患者评估复发和进展风险。将患者分为低、中、高风险组（分别针对复发和进展）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。复发风险为中或高且进展风险为中等的患者应立即进行一次化疗灌注，随后至少进行1年的卡介苗（BCG）膀胱内免疫治疗或进一步的化疗灌注。进展风险高的乳头状肿瘤和CIS应接受1年的膀胱内BCG治疗。对于风险最高的患者可考虑膀胱切除术，至少在BCG治疗失败的患者中推荐进行膀胱切除术。
这些简化的EAU指南提供了关于NMIBC诊断和治疗的最新信息，以便纳入临床实践。
