EAU Guidelines on Non-Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2016
Por:
Babjuk, M, Bohle, A, Burger, M, Capoun, O, Cohen, D, Comperat, EM, Hernandez, V, Kaasinen, E, Palou, J, Roupret, M, van Rhijn, BWG, Shariat, SF, Soukup, V, Sylvester, RJ, Zigeuner, R
Publicada:
1 mar 2017
Resumen:
Context: The European Association of Urology (EAU) panel on Non-muscle-invasive Bladder Cancer (NMIBC) released an updated version of the guidelines on Non-muscle-invasive Bladder Cancer.
Objective: To present the 2016 EAU guidelines on NMIBC.
Evidence acquisition: A broad and comprehensive scoping exercise covering all areas of the NMIBC guidelines published between April 1, 2014, and May 31, 2015, was performed. Databases covered by the search included Medline, Embase, and the Cochrane Libraries. Previous guidelines were updated, and levels of evidence and grades of recommendation were assigned.
Evidence synthesis: Tumours staged as TaT1 or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection of the bladder (TURB) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TURB is essential for the patient's prognosis. If the initial resection is incomplete, there is no muscle in the specimen, or a high-grade or 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 and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups is pivotal to recommending adjuvant treatment. For patients with a low-risk tumour and intermediate-risk patients at a lower risk of recurrence, one immediate instillation of chemotherapy is recommended. Patients with an intermediate-risk tumour 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 highest risk of tumour progression, immediate radical cystectomy (RC) should be considered. RC is recommended in BCG-refractory tumours. The long version of the guidelines is available at the EAU Web site (www.uroweb.org/guidelines).
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 has released updated guidelines on Non-muscle-invasive Bladder Cancer (NMIBC). Stratification of patients into low-, intermediate-, and high-risk groups is essential for decisions about adjuvant intravesical instillations. Risk tables can be used to estimate risks of recurrence and progression. Radical cystectomy should be considered only in case of failure of instillations or in NMIBC with the highest risk of progression. (C) 2016 Published by Elsevier B.V. on behalf of European Association of Urology.
Filiaciones:
Babjuk, M:
Charles Univ Prague, Fac Med 2, Hosp Motol, Dept Urol, V Uvalu 84, Prague 15006 5, Czech Republic
Bohle, A:
HELIOS Agnes Karll Krankenhaus, Dept Urol, Bad Schwartau, Germany
Burger, M:
Univ Regensburg, Dept Urol, Caritas St Josef Med Ctr, Regensburg, Germany
Capoun, O:
Charles Univ Prague, Dept Urol, Gen Univ Hosp, Fac Med 1, Prague, Czech Republic
Cohen, D:
Imperial Coll London, Dept Surg & Canc, London, England
East & North Hertfordshire NHS Trust, Dept Urol, Lister Hosp, Stevenage, Herts, England
Comperat, EM:
UPMC, Hop La Pitie Salpetriere, Dept Pathol, Paris, France
Hernandez, V:
Hosp Univ Fdn Alcorcon, Dept Urol, Madrid, Spain
Kaasinen, E:
Hyvinkaa Hosp, Dept Urol, Hyvinkaa, Finland
Palou, J:
Univ Autonoma Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Roupret, M:
Hop La Pitie Salpetriere, AP HP, Serv Urol, Paris, France
UPMC Univ Paris 06, GRC5, ONCOTYPE Uro, Inst Univ Cancerol, Paris, France
van Rhijn, BWG:
Antoni van Leeuwenhoek Hosp, Dept Surg Oncol Urol, Netherlands Canc Inst, Amsterdam, Netherlands
Shariat, SF:
Med Univ Vienna, Vienna Gen Hosp, Vienna, Austria
Soukup, V:
Charles Univ Prague, Dept Urol, Gen Univ Hosp, Fac Med 1, Prague, Czech Republic
Sylvester, RJ:
European Assoc Urol Guidelines Off, Brussels, Belgium
Zigeuner, R:
Med Univ Graz, Dept Urol, Graz, Austria
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