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
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
Prog Urol. 2019 Sep 20;28(S1):R48-R80. doi: 10.1016/j.purol.2019.01.006.
To propose updated French guidelines for non-muscle invasive (NMIBC) and muscle-invasive (MIBC) bladder cancers.
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.
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.
These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment for NMIBC and MIBC.
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。
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。
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。
这些更新后的法国指南将有助于提高NMIBC和MIBC诊断及治疗的泌尿外科护理水平。
