European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ)-2019 Update
Por:
Babjuk, M, Burger, M, Comperat, EM, Gontero, P, Mostafid, AH, Palou, J, van Rhijn, BWG, Roupret, M, Shariat, SF, Sylvester, R, Zigeuner, R, Capoun, O, Cohen, D, Escrig, JLD, Hernandez, V, Peyronnet, B, Seisen, T, Soukup, V
Publicada:
1 nov 2019
Resumen:
Context: This overview presents the updated European Association of Urology (EAU) guidelines for non-muscle-invasive bladder cancer (NMIBC), TaT1, and carcinoma in situ (CIS).
Objective: To provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation and recommendations.
Evidence acquisition: A broad and comprehensive scoping exercise covering all areas of the NMIBC guidelines has been performed annually since the last published version in 2017. Databases covered by the search included Medline, EMBASE, and the Cochrane Libraries. Previous guidelines were updated, and the level of evidence and grade of recommendation were assigned.
Evidence synthesis: Tumours staged as Ta, T1, and/or CIS are grouped under the heading of NMIBC. Diagnosis depends on cystoscopy and histological evaluation of the tissue obtained by transurethral resection (TURB) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TURB is essential for the patient's prognosis and correct diagnosis. Where the initial resection is incomplete, where there is no muscle in the specimen, or where a T1 tumour is detected, a second TURB should be performed within 2-6 wk. The risks of both recurrence and progression may be estimated for individual patients using the European Organisation for Research and Treatment of Cancer (EORTC) scoring system. Stratification of patients into low-, intermediate-, and high-risk groups is pivotal to the recommendation of adjuvant treatment. In patients with tumours presumed to be at a low risk and in those presumed to be at an intermediate risk with a low previous recurrence rate and an expected EORTC recurrence score of <5, one immediate chemotherapy instillation is recommended. Patients with intermediate-risk tumours should receive 1 yr of full-dose bacillus Calmette-Guerin (BCG) intravesical immunotherapy or instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. In patients at the highest risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is recommended in BCG-unresponsive tumours. The extended version of the guidelines is available at the EAU website: https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/.
Conclusions: These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.
Patient summary: The European Association of Urology Non-muscle-invasive Bladder Cancer (NMIBC) Panel has released an updated version of their guidelines, which contains information on classification, risk factors, diagnosis, prognostic factors, and treatment of NMIBC. The recommendations are based on the current literature (until the end of 2018), with emphasis on high-level data from randomised clinical trials and meta-analyses. Stratification of patients into low-, intermediate-, and high-risk groups is essential for deciding appropriate use of adjuvant intravesical chemotherapy or bacillus Calmette-Guerin (BCG) instillations. Surgical removal of the bladder should be considered in case of BCG-unresponsive tumours or in NMIBCs with the highest risk of progression. (C) 2019 Published by Elsevier B.V. on behalf of European Association of Urology.
Filiaciones:
Babjuk, M:
Charles Univ Prague, Hosp Motol, Fac Med 2, Dept Urol, Prague, Czech Republic
Med Univ Vienna, Dept Urol, Vienna, Austria
Burger, M:
Univ Regensburg, Caritas St Josef Med Ctr, Dept Urol, Regensburg, Germany
Comperat, EM:
UPMC Paris VI, Hop Tenon, AP HP, Dept Pathol, Paris, France
Gontero, P:
Univ Studies Torino, Molinette Hosp, Div Urol, Turin, Italy
Mostafid, AH:
Royal Surrey Cty Hosp, Dept Urol, Guildford, Surrey, England
Palou, J:
Univ Autonoma Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
van Rhijn, BWG:
Univ Regensburg, Caritas St Josef Med Ctr, Dept Urol, Regensburg, Germany
Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Surg Oncol Urol, Amsterdam, Netherlands
Roupret, M:
Sorbonne Univ, Hop Pitie Salpetriere, AP HP, ONCOTYPE URO,Urol Dept,GRC Ndeg5, Paris, France
Shariat, SF:
Charles Univ Prague, Hosp Motol, Fac Med 2, Dept Urol, Prague, Czech Republic
Med Univ Vienna, Dept Urol, Vienna, Austria
Weill Cornell Med Coll, Dept Urol, New York, NY USA
Univ Texas Southwestern Med Ctr Dallas, Dept Urol, Dallas, TX 75390 USA
IM Sechenov First Moscow State Med Univ, Inst Urol & Reprod Hlth, Moscow, Russia
Sylvester, R:
European Assoc Urol Guidelines Off, Brussels, Belgium
Zigeuner, R:
Med Univ Graz, Dept Urol, Graz, Austria
Capoun, O:
Charles Univ Prague, Gen Univ Hosp, Fac Med 1, Dept Urol, Prague, Czech Republic
Cohen, D:
Royal Free London NHS Fdn Trust, Dept Urol, London, England
Escrig, JLD:
Fdn Inst Valenciano Oncol, Dept Urol, Valencia, Spain
Hernandez, V:
Hosp Univ Fdn Alcorcon, Dept Urol, Madrid, Spain
Peyronnet, B:
Univ Rennes, Dept Urol, Rennes, France
Seisen, T:
Sorbonne Univ, Hop Pitie Salpetriere, AP HP, ONCOTYPE URO,Urol Dept,GRC Ndeg5, Paris, France
Soukup, V:
Charles Univ Prague, Gen Univ Hosp, Fac Med 1, Dept Urol, Prague, Czech Republic
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