Pfister C, Roupret M, Neuzillet Y, Larré S, Pignot G, Quintens H, Houedé N, Compérat E, Colin P, Roy C, Davin J-L, Guy L, Irani J, Lebret T, Coloby P, Soulié M
Membres expert du sous-comité vessie.
Prog Urol. 2013 Nov;23 Suppl 2:S105-25. doi: 10.1016/S1166-7087(13)70049-6.
The objective was to update the guidelines of the French Urological Association Cancer Committee for non invasive (NMIBC) and invasive bladder cancer (MIBC).
A Medline search was performed between 2010 and 2013, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence.
Diagnosis of NMIBC (Ta, T1, CIS) depends on cystoscopy and complete deep resection of the tumour. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on pelvic-abdominal and thoracic CT-scan, MRI and FDGPET remain optional. Cystectomy associated with extensive lymph nodes resection is considered the gold standard for non metastatic MIBC. An orthotopic bladder substitution should be proposed to both male and female patients lacking any contraindications and in cases of negative frozen urethral samples, otherwise trans-ileal ureterostomy is recommended as urinary diversion. The interest of neoadjuvant chemotherapy is well known for advanced MIBC as T3-T4 and/or N1-3. As regards metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when status (PS<1) and renal function (creatinine clearance > 60 ml/min) permits (only in 50% of cases). In second line treatment, only chemotherapy using vinfluvine has been validated to date. Conclusion.-These new guidelines will hopefully contribute not only to improve patient management, but also diagnosis and treatment for NMIBC and MIBC.
目的是更新法国泌尿外科学会癌症委员会关于非侵袭性膀胱癌（NMIBC）和侵袭性膀胱癌（MIBC）的指南。
于2010年至2013年期间进行了一项医学文献数据库检索，内容涉及膀胱癌的诊断、治疗选择及随访，以评估不同证据水平的参考文献。
NMIBC（Ta、T1、CIS）的诊断依赖于膀胱镜检查及肿瘤的完整深部切除。使用荧光检查及二次检查指征对于改善初始诊断至关重要。复发和进展风险可通过欧洲癌症研究与治疗组织（EORTC）评分进行评估。将患者分为低、中、高风险组对于推荐辅助治疗至关重要：术后即刻化疗灌注（标准方案）或膀胱内卡介苗灌注（标准方案及维持治疗）。对于卡介苗难治性患者，建议行膀胱切除术。MIBC的分期评估基于盆腔 - 腹部及胸部CT扫描，MRI和氟代脱氧葡萄糖正电子发射断层显像（FDGPET）仍为可选项。膀胱切除术联合广泛淋巴结清扫被认为是非转移性MIBC的金标准。对于无任何禁忌证且尿道冰冻切片阴性的男性和女性患者，应建议行原位膀胱替代术，否则推荐行回肠代输尿管造口术作为尿液改道术。新辅助化疗对于T3 - T4期和/或N1 - 3期的晚期MIBC的益处已为人所知。对于转移性MIBC，当患者状态（体力状况评分<1）和肾功能（肌酐清除率>60 ml/min）允许时（仅50%的病例），推荐使用铂类进行一线化疗（吉西他滨联合顺铂或甲氨蝶呤、长春花碱、阿霉素、顺铂）。在二线治疗中，迄今为止仅有长春氟宁化疗得到验证。结论。这些新指南有望不仅有助于改善患者管理，还能改善NMIBC和MIBC的诊断及治疗。
