Campistol Míriam, Lozano Fernando, Carrion Albert, Raventós Carles Xavier, Morote Juan, Trilla Enrique
Department of Urology, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035 Barcelona, Spain.
Department of Surgery, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain.
Cancers (Basel). 2025 May 20;17(10):1714. doi: 10.3390/cancers17101714.
Bladder cancer is the ninth most common cancer globally, with most cases classified as non-muscle-invasive bladder cancer (NMIBC). While transurethral resection of the bladder tumor (TURBT) remains the gold-standard treatment, its complications, high recurrence rates, and economic burden have prompted interest in alternative strategies like active surveillance (AS) for low-grade and low-grade NMBIC recurrences. AS minimizes surgical interventions and patient burden, but lacks standardized protocols for inclusion criteria and follow-up schedules. Most studies suggest intensive monitoring during the first year, with criteria often based on tumor size, number, and grade.
A comprehensive literature search was conducted in December 2024 using Pubmed, Cochrane, and Trip databases to identify studies on AS for low-grade NMBIC recurrences. Only English studies were included, with Boolean operators used to refine the search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Population, Intervention, Comparison and Outcomes (PICO) selection criteria were followed. The Newcastle-Ottawa quality assessment scale was used to analyze the quality of the included studies.
This systematic review included 11 studies evaluating AS for NMIBC. Early studies, such demonstrated AS as a feasible alternative to TURBT, with low progression rates. Subsequent research confirmed its safety in selected patients, with tumor growth and positive cytology being the main reasons for intervention. More recent investigations, further supported AS as a viable strategy, highlighting the low risk of stage and grade progression and its potential to reduce surgical interventions.
AS may be considered an alternative approach for low-risk NMIBC recurrences. However, there is need for prospective studies and personalized approaches to optimize AS, addressing follow-up strategies, inclusion criteria and progression thresholds.
膀胱癌是全球第九大常见癌症，大多数病例被归类为非肌层浸润性膀胱癌（NMIBC）。虽然经尿道膀胱肿瘤切除术（TURBT）仍然是金标准治疗方法，但其并发症、高复发率和经济负担促使人们对诸如主动监测（AS）等替代策略产生兴趣，用于低级别和低级别NMBIC复发。AS可将手术干预和患者负担降至最低，但缺乏纳入标准和随访时间表的标准化方案。大多数研究建议在第一年进行强化监测，标准通常基于肿瘤大小、数量和分级。
2024年12月使用PubMed、Cochrane和Trip数据库进行了全面的文献检索，以确定关于低级别NMBIC复发的AS研究。仅纳入英文研究，使用布尔运算符细化检索。遵循系统评价和Meta分析的首选报告项目（PRISMA）指南以及人群、干预、对照和结局（PICO）选择标准。使用纽卡斯尔-渥太华质量评估量表分析纳入研究的质量。
本系统评价纳入了11项评估NMIBC的AS的研究。早期研究表明AS是TURBT可行的替代方法，进展率较低。随后的研究证实了其在选定患者中的安全性，肿瘤生长和阳性细胞学是干预的主要原因。最近的调查进一步支持AS作为一种可行的策略，强调分期和分级进展的低风险及其减少手术干预的潜力。
AS可被视为低风险NMIBC复发的替代方法。然而，需要进行前瞻性研究和个性化方法来优化AS，解决随访策略、纳入标准和进展阈值问题。
