Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline

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• 作者：Sam S. Chang ; Stephen A. Boorjian ; Roger Chou ; Peter E. Clark ; Siamak Daneshmand ; Badrinath R. Konety ; Raj Pruthi ; Diane Z. Quale ; Chad R. Ritch ; John D. Seigne ; Eila Curlee Skinner ; Norm D. Smith ; James M. McKiernan
• 关键词：urinary bladder neoplasms ; cystectomy ; drug therapy ; immunotherapy
• 刊名：The Journal of Urology
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：196
• 期：4
• 页码：1021-1029
• 全文大小：298 K

文摘

Although associated with an overall favorable survival rate, the heterogeneity of non-muscle invasive bladder cancer (NMIBC) affects patients’ rates of recurrence and progression. Risk stratification should influence evaluation, treatment and surveillance. This guideline attempts to provide a clinical framework for the management of NMIBC.

Materials and Methods

A systematic review utilized research from the Agency for Healthcare Research and Quality (AHRQ) and additional supplementation by the authors and consultant methodologists. Evidence-based statements were based on body of evidence strength Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions.n id="bbib1">¹n>

Results

A risk-stratified approach categorizes patients into broad groups of low-, intermediate-, and high-risk. Importantly, the evaluation and treatment algorithm takes into account tumor characteristics and uniquely considers a patient’s response to therapy. The 38 statements vary in level of evidence, but none include Grade A evidence, and many were Grade C.

Conclusion

The intensity and scope of care for NMIBC should focus on patient, disease, and treatment response characteristics. This guideline attempts to improve a clinician’s ability to evaluate and treat each patient, but higher quality evidence in future trials will be essential to improve level of care for these patients.