Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Eur Urol Focus. 2019 Jul;5(4):681-688. doi: 10.1016/j.euf.2017.09.002. Epub 2017 Oct 23.
The European Association of Urology (EAU) non-muscle-invasive bladder cancer (NMIBC) guidelines are meant to help minimise morbidity and improve the care of patients with NMIBC. However, there may be underuse of guideline-recommended care in this potentially curable cohort.
To assess European physicians' current practice in the management of NMIBC and evaluate its concordance with the EAU 2013 guidelines.
DESIGN, SETTING, AND PARTICIPANTS: Initial 45-min telephone interviews were conducted with 20 urologists to develop a 26-item questionnaire for a 30-min online quantitative interview. A total of 498 physicians with predefined experience in treatment of NMIBC patients, from nine European countries, completed the online interviews.
Descriptive statistics of absolute numbers and percentages of the use of diagnostic tools, risk group stratification, treatment options chosen, and follow-up regimens were used.
Guidelines are used by ≥87% of physicians, with the EAU guidelines being the most used ones (71-100%). Cystoscopy (60-97%) and ultrasonography (42-95%) are the most used diagnostic techniques. Using EAU risk classification, 40-69% and 88-100% of physicians correctly identify all the prognostic factors for low- and high-risk tumours, respectively. Re-transurethral resection of the bladder tumour (re-TURB) is performed in 25-75% of low-risk and 55-98% of high-risk patients. Between 21% and 88% of patients received a single instillation of chemotherapy within 24h after TURB. Adjuvant intravesical treatment is not given to 6-62%, 2-33%, and 1-20% of the patients with low-, intermediate-, and high-risk NMIBC, respectively. Patients with low-risk NMIBC are likely to be overmonitored and those with high-risk NMIBC undermonitored. Our study is limited by the possible recall bias of the selected physicians.
Although most European physicians claim to apply the EAU guidelines, adherence to them is low in daily practice.
Our survey among European physicians investigated discrepancies between guidelines and daily practice in the management of non-muscle-invasive bladder cancer (NMIBC). We conclude that the use of the recommended diagnostic tools, risk-stratification of NMIBC, and performance of re-TURB have been adopted, but adjuvant intravesical treatment and follow-up are not uniformly applied.
欧洲泌尿外科学会（EAU）非肌肉浸润性膀胱癌（NMIBC）指南旨在帮助减少发病率并改善 NMIBC 患者的护理。然而，在这个潜在可治愈的患者群体中，可能存在指南推荐护理的使用不足的情况。
评估欧洲医生在 NMIBC 管理中的当前实践，并评估其与 EAU 2013 指南的一致性。
设计、设置和参与者：对 20 名泌尿科医生进行了初始 45 分钟的电话访谈，以制定 26 项用于 30 分钟在线定量访谈的问卷。来自九个欧洲国家的 498 名具有 NMIBC 患者治疗经验的医生完成了在线访谈。
使用诊断工具使用、风险组分层、选择的治疗方案和随访方案的绝对数字和百分比的描述性统计数据。
≥87%的医生使用指南，其中 EAU 指南使用最多（71-100%）。膀胱镜检查（60-97%）和超声检查（42-95%）是最常用的诊断技术。使用 EAU 风险分类，分别有 40-69%和 88-100%的医生正确识别低危和高危肿瘤的所有预后因素。在低危患者中，25-75%的患者和高危患者中 55-98%的患者进行了再次经尿道膀胱肿瘤切除术（re-TURB）。21%-88%的患者在 TURB 后 24 小时内接受单次膀胱内化疗灌注。低、中、高危 NMIBC 患者分别有 6-62%、2-33%和 1-20%未接受辅助膀胱内治疗。低危 NMIBC 患者可能过度监测，高危 NMIBC 患者监测不足。我们的研究受到所选医生可能存在回忆偏倚的限制。
尽管大多数欧洲医生声称应用 EAU 指南，但在日常实践中，对其的依从性较低。
我们对欧洲医生的调查研究了非肌肉浸润性膀胱癌（NMIBC）管理中指南与日常实践之间的差异。我们得出的结论是，已经采用了推荐的诊断工具、NMIBC 的风险分层和再 TURB 的应用，但辅助膀胱内治疗和随访并没有得到统一应用。
