Context

The European Association of Urology (EAU) has released an updated version of the guidelines on non–muscle-invasive bladder cancer (NMIBC).

Objective

To present the 2021 EAU guidelines on NMIBC.

Evidence acquisition

A broad and comprehensive scoping exercise covering all areas of the NMIBC guidelines since the 2020 version was performed. 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 carcinoma in situ (CIS) are grouped under the heading of NMIBC. Diagnosis depends on cystoscopy and histological evaluation of tissue obtained via transurethral resection of the bladder (TURB) for papillary tumours or via multiple bladder biopsies for CIS. For papillary lesions, a complete TURB is essential for the patient’s prognosis and correct diagnosis. In cases for which the initial resection is incomplete, there is no muscle in the specimen, or a T1 tumour is detected, a second TURB should be performed within 2–6 wk. The risk of progression may be estimated for individual patients using the 2021 EAU scoring model. On the basis of their individual risk of progression, patients are stratified as having low, intermediate, high, or very high risk, which is pivotal to recommending adjuvant treatment. For patients with tumours presumed to be at low risk and for small papillary recurrences detected more than 1 yr after a previous TURB, one immediate chemotherapy instillation is recommended. Patients with an intermediate-risk tumour should receive 1 yr of full-dose intravesical bacillus Calmette-Guérin (BCG) immunotherapy or instillations of chemotherapy for a maximum of 1 yr. For patients with high-risk tumours, full-dose intravesical BCG for 1–3 yr is indicated. For patients at very high risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is also recommended for BCG-unresponsive tumours. The extended version of the guidelines is available on the EAU website at 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 has released updated guidelines on the classification, risk factors, diagnosis, prognostic factors, and treatment of non–muscle-invasive bladder cancer. The recommendations are based on the literature up to 2020, with emphasis on the highest level of evidence. Classification of patients as having low, intermediate, or and high risk is essential in deciding on suitable treatment. Surgical removal of the bladder should be considered for tumours that do not respond to bacillus Calmette-Guérin (BCG) treatment and tumours with the highest risk of progression.

中文翻译：

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欧洲泌尿外科协会非肌肉浸润性膀胱癌指南（Ta、T1 和原位癌）

语境

欧洲泌尿外科协会 (EAU) 发布了非肌肉浸润性膀胱癌 (NMIBC) 指南的更新版本。

客观的

介绍关于 NMIBC 的 2021 EAU 指南。

取证

自执行 2020 版以来，涵盖 NMIBC 指南所有领域的广泛而全面的范围界定工作。搜索涵盖的数据库包括 Medline、EMBASE 和 Cochrane 图书馆。更新了以前的指南，并指定了证据级别和推荐等级。

证据综合

分期为 Ta、T1 和原位癌 (CIS) 的肿瘤归入 NMIBC 标题下。诊断取决于膀胱镜检查和通过经尿道膀胱切除术 (TURB) 获得的组织的组织学评估，用于乳头状肿瘤或通过多次膀胱活检获得 CIS。对于乳头状病变，完整的TURB对于患者的预后和正确诊断至关重要。如果初始切除不完全，标本中没有肌肉，或检测到 T1 肿瘤，则应在 2-6 周内进行第二次 TURB。可以使用 2021 EAU 评分模型估计个体患者的进展风险。根据患者的个体进展风险，将患者分为低、中、高或非常高风险，这对于推荐辅助治疗至关重要。对于推定为低风险的肿瘤患者以及在之前的 TURB 后 1 年以上检测到小的乳头状复发的患者，建议立即进行一次化疗滴注。中危肿瘤患者应接受 1 年的全剂量膀胱内卡介苗 (BCG) 免疫治疗或最多 1 年的化疗滴注。对于高危肿瘤患者，建议使用全剂量膀胱内卡介苗 1-3 年。对于肿瘤进展风险非常高的患者，应考虑立即进行根治性膀胱切除术。对于 BCG 无反应的肿瘤，也建议进行膀胱切除术。指南的扩展版本可在 EAU 网站 https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/ 上获得。

结论

这些删节的 EAU 指南提供了有关 NMIBC 诊断和治疗的最新信息，以供纳入临床实践。

患者总结

欧洲泌尿外科协会发布了关于非肌层浸润性膀胱癌分类、危险因素、诊断、预后因素和治疗的最新指南。这些建议基于截至 2020 年的文献，重点是最高级别的证据。将患者分类为低、中或高风险对于决定合适的治疗至关重要。对于对卡介苗 (BCG) 治疗无反应的肿瘤和进展风险最高的肿瘤，应考虑手术切除膀胱。