Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Curr Opin Urol. 2022 Sep 1;32(5):567-574. doi: 10.1097/MOU.0000000000001028. Epub 2022 Jul 22.
This review aims to analyze the current place of active surveillance (AS) in non-muscle-invasive bladder cancer (NMIBC).
A growing body of evidence suggests that AS protocols for pTa low-grade (TaLG) NMIBC are safe and feasible. However, current guidelines have not implemented AS due to a lack of high-quality data. Available studies included pTa tumors, with only one study excluding pT1-NMIBC. Inclusion/exclusion criteria were heterogeneously defined based on tumor volume, number of tumors, carcinoma in situ (CIS), or high-grade (HG) NMIBC. Tumor volume <10 mm and <5 lesions were used as cut-offs. Positive urinary cytology (UC) or cancer-related symptoms precluded inclusion. Surveillance within the first year consisted of quarterly cystoscopy. AS stopped upon the presence of cancer-related symptoms, change in tumor morphology, positive UC, or patient's request. With a median time on AS of 16 months, two-thirds of the patients failed AS. Progression to muscle-invasive bladder cancer (MIBC) was rare and occurred only in patients with pT1-NIMBC at inclusion.
AS in NMIBC is an attractive concept in the era of personalized medicine, but strong evidence is still awaited. A more precise definition of patient inclusion, follow-up, and failure criteria is required to improve its implementation in daily clinical practice.
本文旨在分析主动监测（AS）在非肌层浸润性膀胱癌（NMIBC）中的当前地位。
越来越多的证据表明，pTa 低级别（TaLG）NMIBC 的 AS 方案是安全且可行的。然而，由于缺乏高质量的数据，目前的指南尚未实施 AS。现有研究包括 pTa 肿瘤，仅有一项研究排除了 pT1-NMIBC。纳入/排除标准基于肿瘤体积、肿瘤数量、原位癌（CIS）或高级别（HG）NMIBC 而存在差异。肿瘤体积<10mm 和<5 个肿瘤被用作截断值。阳性尿细胞学（UC）或与癌症相关的症状排除在外。第一年的监测包括每季度进行膀胱镜检查。一旦出现与癌症相关的症状、肿瘤形态改变、阳性 UC 或患者要求，AS 即停止。AS 的中位时间为 16 个月，三分之二的患者 AS 失败。进展为肌层浸润性膀胱癌（MIBC）的情况罕见，仅发生在纳入时患有 pT1-NIMBC 的患者中。
在个性化医学时代，NMIBC 的 AS 是一个有吸引力的概念，但仍需要更多的证据。需要更精确地定义患者纳入、随访和失败标准，以提高其在日常临床实践中的应用。
