BACKGROUND Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. OBJECTIVE To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. DESIGN A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts prior to voting during a consensus conference. SETTING Online Delphi survey and consensus conference. PARTICIPANTS The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), and 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). RESULTS AND LIMITATIONS Overall, 116 statements were included in the Delphi survey. Of these statements, 33 (28%) achieved level 1 consensus and 49 (42%) achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease, and the evolving role of checkpoint inhibitor therapy in metastatic disease. CONCLUSIONS These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time when further evidence is available to guide our approach. PATIENT SUMMARY This report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available.

中文翻译：

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EAU-ESMO 关于晚期和变异膀胱癌管理的共识声明 - 国际多利益相关方协作努力†：在 EAU-ESMO 指南委员会的支持下。


背景尽管存在晚期和变异膀胱癌治疗的指南，但某些领域的证据有限/相互矛盾，并且最佳方法仍然存在争议。目的 汇集大型多学科专家小组，就膀胱癌治疗中的争议话题制定共识声明。设计 指导委员会编制了有关晚期和变异膀胱癌治疗的拟议声明，并由 113 名专家在德尔福调查中进行了评估。对未达成共识的声明进行了审查；在共识会议上投票之前，由 45 名专家组成的小组对优先事项进行了修订。设置 在线德尔福调查和共识会议。参与者欧洲泌尿外科协会 (EAU)、欧洲肿瘤内科学会 (ESMO)、膀胱癌治疗专家。结果测量和统计分析 专家根据同意程度对陈述进行排名：1-3（不同意）、4-6（模棱两可）和7-9（同意）。先验（1 级）共识定义为≥70% 一致且≤15% 不一致，反之亦然。在德尔福调查中，第二次分析仅限于被认为拥有与每项声明相关的足够专业知识的利益相关者群体（以达成 2 级共识）。结果和局限性 总体而言，德尔福调查包含 116 条陈述。其中，33 份 (28%) 达成了 1 级共识，49 份 (42%) 达成了 1 级或 2 级共识。在共识大会上，27 份发言中有 22 份（81%）达成共识。 这些共识声明为广泛的主题提供了进一步的指导，包括变异组织学的管理、预后生物标志物在临床决策中的作用/局限性、膀胱保留策略、现代放射治疗技术、寡转移性疾病的管理以及不断发展的作用检查点抑制剂治疗转移性疾病的研究。结论 这些共识声明为晚期和变异膀胱癌治疗中的争议话题提供了进一步的指导，直到有进一步的证据来指导我们的方法。患者摘要 本报告总结了由 EAU 和 ESMO 组织的国际多利益相关方项目的调查结果。在该项目中，指导委员会确定了目前没有高质量证据来指导治疗决策的膀胱癌管理领域。由此，他们制定了一系列拟议声明，其中 71 项声明得到了膀胱癌领域众多专家的共识。预计这些声明将为医疗保健专业人员提供进一步的指导，并有助于改善患者的治疗结果，直到获得高质量的证据。