Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic.
Department of Urology, HELIOS Agnes-Karll-Krankenhaus, Bad Schwartau, Germany.
Eur Urol. 2017 Mar;71(3):447-461. doi: 10.1016/j.eururo.2016.05.041. Epub 2016 Jun 17.
The European Association of Urology (EAU) panel on Non-muscle-invasive Bladder Cancer (NMIBC) released an updated version of the guidelines on Non-muscle-invasive Bladder Cancer.
To present the 2016 EAU guidelines on NMIBC.
A broad and comprehensive scoping exercise covering all areas of the NMIBC guidelines published between April 1, 2014, and May 31, 2015, was performed. Databases covered by the search included Medline, Embase, and the Cochrane Libraries. Previous guidelines were updated, and levels of evidence and grades of recommendation were assigned.
Tumours staged as TaT1 or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection of the bladder (TURB) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TURB is essential for the patient's prognosis. If the initial resection is incomplete, there is no muscle in the specimen, or a high-grade or T1 tumour is detected, a second TURB should be performed within 2-6 wk. The risks of both recurrence and progression may be estimated for individual patients using the European Organisation for Research and Treatment of Cancer (EORTC) scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups is pivotal to recommending adjuvant treatment. For patients with a low-risk tumour and intermediate-risk patients at a lower risk of recurrence, one immediate instillation of chemotherapy is recommended. Patients with an intermediate-risk tumour should receive 1 yr of full-dose bacillus Calmette-Guérin (BCG) intravesical immunotherapy or instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. In patients at highest risk of tumour progression, immediate radical cystectomy (RC) should be considered. RC is recommended in BCG-refractory tumours. The long version of the guidelines is available at the EAU Web site (www.uroweb.org/guidelines).
These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.
The European Association of Urology has released updated guidelines on Non-muscle-invasive Bladder Cancer (NMIBC). Stratification of patients into low-, intermediate-, and high-risk groups is essential for decisions about adjuvant intravesical instillations. Risk tables can be used to estimate risks of recurrence and progression. Radical cystectomy should be considered only in case of failure of instillations or in NMIBC with the highest risk of progression.
欧洲泌尿外科学会（EAU）非肌层浸润性膀胱癌（NMIBC）小组发布了 NMIBC 指南的更新版本。
介绍 2016 年 EAU 关于 NMIBC 的指南。
对 2014 年 4 月 1 日至 2015 年 5 月 31 日期间发表的 NMIBC 指南的所有领域进行了广泛而全面的扫描。搜索涵盖的数据库包括 Medline、Embase 和 Cochrane 图书馆。更新了以前的指南，并分配了证据水平和推荐等级。
分期为 TaT1 或原位癌（CIS）的肿瘤被归类为 NMIBC。诊断取决于膀胱镜检查和经尿道膀胱肿瘤切除术（TURB）获得的组织的组织学评估，或 CIS 中多发性膀胱活检。在乳头状病变中，完整的 TURB 对患者的预后至关重要。如果初始切除不完全，标本中没有肌肉，或者检测到高级或 T1 肿瘤，则应在 2-6 周内进行第二次 TURB。可以使用欧洲癌症研究与治疗组织（EORTC）评分系统和风险表来估计单个患者的复发和进展风险。将患者分层为低风险、中风险和高风险组对于推荐辅助治疗至关重要。对于低风险肿瘤和复发风险较低的中风险患者，建议立即进行一次化疗灌注。对于中风险肿瘤患者，建议接受 1 年全剂量卡介苗（BCG）膀胱内免疫治疗或最多 1 年的化疗灌注。对于高风险肿瘤患者，建议使用全剂量 BCG 进行 1-3 年膀胱内治疗。对于肿瘤进展风险最高的患者，应考虑立即根治性膀胱切除术（RC）。BCG 耐药肿瘤推荐 RC。指南的长版本可在 EAU 网站（www.uroweb.org/guidelines）上获得。
这些简化的 EAU 指南提供了 NMIBC 诊断和治疗的最新信息，以便纳入临床实践。
欧洲泌尿外科学会发布了更新的非肌层浸润性膀胱癌（NMIBC）指南。将患者分层为低风险、中风险和高风险组对于辅助膀胱内灌注的决策至关重要。风险表可用于估计复发和进展的风险。只有在灌注失败或 NMIBC 具有最高进展风险的情况下，才应考虑根治性膀胱切除术。
