Department of Urology, University Medical Center Nijmegen, Radboudumc (610), P. O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
World J Urol. 2021 Nov;39(11):4047-4053. doi: 10.1007/s00345-020-03569-2. Epub 2020 Dec 26.
Patients with non-muscle invasive bladder cancer (NMIBC) have high recurrence and progression rates in spite of tumor resection and adjuvant instillation therapy. To detect recurrences and progression, these patients remain under frequent follow-up. Follow-up, however, is not well defined. Frequency and duration of follow recommendations are based on low levels of evidence, which is illustrated by clear differences in these recommendations per guideline, even when specified per risk group. Additionally, follow-up is recommended with cystoscopy and cytology in selected patients, which both have clear limitations. Fact is that follow-up in NMIBC is too frequent, with low levels of evidence and suboptimal tools, and it is patient unfriendly and costly. Improved cystoscopy techniques are unproven or impractical in the outpatient follow-up setting. Urinary markers have been around for decades, but never widely used in clinical practice. New (epi)genetic markers, however, could play a significant role in future follow-up of NMIBC. They have been shown to have very high negative predictive values for recurrences in follow-up of NMIBC, especially high-grade recurrences. Several studies suggested that these markers could be used to adapt follow-up cystoscopy frequency. What still needs study and confirmation is the cost-effectiveness of the use of these markers, which is highly dependent on health care costs per country and marker price. In all, however, implementation of these new urinary markers after confirmation of current results might significantly reduce patient burden and health care costs in the near future without reducing quality.
尽管进行了肿瘤切除和辅助灌注治疗，患有非肌肉浸润性膀胱癌（NMIBC）的患者仍有很高的复发和进展率。为了检测复发和进展，这些患者需要进行频繁的随访。然而，随访的定义并不明确。随访建议的频率和持续时间基于低水平的证据，这从指南之间的明显差异中可以看出，即使是按照风险组进行了具体规定。此外，在选定的患者中，推荐进行膀胱镜检查和细胞学检查以进行随访，但这两种方法都有明显的局限性。事实上，NMIBC 的随访过于频繁，证据水平低，工具也不理想，而且对患者不友好且成本高昂。改良的膀胱镜检查技术在门诊随访环境中尚未得到证实或不实用。尿液标志物已经存在了几十年，但从未广泛应用于临床实践。新的（表观遗传学）标志物可能在未来的 NMIBC 随访中发挥重要作用。它们已被证明对 NMIBC 随访中的复发具有非常高的阴性预测值，尤其是高级别复发。几项研究表明，这些标志物可用于调整随访膀胱镜检查的频率。仍需要研究和确认的是这些标志物的成本效益，这高度依赖于每个国家的医疗保健成本和标志物价格。总之，在确认当前结果后实施这些新的尿液标志物，可能会在不久的将来显著降低患者负担和医疗保健成本，而不会降低质量。
