[法国卡介苗无应答（ccAFU）指南 - 2018 - 2020年更新：膀胱癌]

[French ccAFU guidelines – Update 2018–2020: Bladder cancer].

作者信息

Rouprêt M, Neuzillet Y, Pignot G, Compérat E, Audenet F, Houédé N, Larré S, Masson-Lecomte A, Colin P, Brunelle S, Xylinas E, Roumiguié M, Méjean A

机构信息

Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France

GRC no 5, ONCOTYPE-URO, hôpital Pitié-Salpêtrière, Sorbonne université, AP–HP, 75013 Paris, France

出版信息

Prog Urol. 2019 Sep 20;28(S1):R48-R80. doi: 10.1016/j.purol.2019.01.006.

DOI:10.1016/j.purol.2019.01.006

PMID:32093463

Abstract

OBJECTIVE

To propose updated French guidelines for non-muscle invasive (NMIBC) and muscle-invasive (MIBC) bladder cancers.

METHODS

A Medline search was achieved between 2015 and 2018, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence.

RESULTS

Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. 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 risk 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 contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS < 1) and renal function (creatinine clearance > 60 mL/min) allow it (only in 50 % of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival.

CONCLUSION

These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment for NMIBC and MIBC.

摘要

目的

提出更新后的法国非肌层浸润性（NMIBC）和肌层浸润性（MIBC）膀胱癌诊疗指南。

方法

于2015年至2018年间对Medline进行检索，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。

结果

NMIBC（Ta、T1、CIS）的诊断基于肿瘤的完整深度切除。荧光的应用及二次探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：术后即刻灌注化疗（标准方案）或膀胱内卡介苗灌注（标准方案及维持治疗）。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 - 腹部及胸部增强CT扫描。多参数MRI可作为替代方法。膀胱切除术联合扩大淋巴结清扫术被认为是非转移性MIBC的金标准。符合条件的患者应在术前接受基于顺铂的新辅助化疗。对于无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流改道术。所有患者均应纳入术后早期康复（ERAS）方案。对于转移性MIBC，当体能状态（PS < 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（GC或MVAC）。在二线治疗中，帕博利珠单抗免疫治疗显示总生存期有显著改善。