Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Department of Pathology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Eur Urol. 2014 Apr;65(4):778-92. doi: 10.1016/j.eururo.2013.11.046. Epub 2013 Dec 12.
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.
To provide graded recommendations on the diagnosis and treatment of patients with muscle-invasive BCa (MIBC), linked to a level of evidence.
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.
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.
This 2013 EAU Muscle-invasive and Metastatic BCa guidelines updated summary aims to increase the quality of care and outcome for patients with muscle-invasive or metastatic BCa.
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.
欧洲泌尿外科学会（EAU）肌层浸润性和转移性膀胱癌（BCa）指南小组每年更新其指南。本更新摘要提供了 2013 年指南文件的综合内容，重点介绍了最新进展。
为肌层浸润性膀胱癌（MIBC）患者的诊断和治疗提供分级建议，并与证据水平相关联。
针对指南的每一节，在几个数据库中进行了全面的文献检索，涵盖过去 10 年的文献，然后在小组内和与外部专家一起对检索结果进行扫描、审查和讨论。最终结果反映在提供的建议中。
吸烟和与工作相关的致癌物质仍然是膀胱癌最重要的危险因素。计算机断层扫描（CT）和磁共振成像（MRI）可用于分期，尽管 CT 更适合肺部评估。对于非肌层浸润性和 T2-T4aN0M0BCa 的治疗失败，开放性根治性膀胱切除术联合广泛淋巴结清扫术（LND）仍然是首选治疗方法。然而，对于知情、选择良好且依从性好的患者，可以提供多模式治疗作为替代方案，特别是如果不能进行膀胱切除术。决定是否进行根治性膀胱切除术时，应考虑合并症而非年龄。应鼓励患者积极参与决策过程，并应为所有患者提供控尿性尿流改道术，除非有特定的禁忌症。对于适合的患者，应始终讨论顺铂为基础的新辅助化疗，因为它可以提高总体生存率。对于有转移性疾病的患者，推荐使用含顺铂的联合化疗。对于不适合的患者，可以使用卡铂联合化疗或单药治疗。
本 2013 年 EAU 肌层浸润性和转移性膀胱癌指南更新摘要旨在提高肌层浸润性或转移性膀胱癌患者的护理质量和结局。
在本文中，我们更新了 EAU 关于肌层浸润性和转移性膀胱癌的指南。我们建议在根治性治疗前进行化疗，并建议将膀胱切除术作为疾病局限于膀胱的标准治疗方法。
