High-risk non-muscle-invasive bladder cancer: update for a better identification and treatment

作者：Rodriguez Faba Oscar; Palou Joan; Breda Alberto; Villavicencio H

来源：World Journal of Urology, 2012, 30(6): 833-840.

DOI：10.1007/s00345-012-0967-1

• Transurethral resection (TUR)
• Non-muscle-invasive bladder cancer (NMIBC)
• High-risk bladder cancer (HRBC)
• Bacillus Calmette-Guerin (BCG)
• Photodynamic diagnosis (PDD)
• Disease-specific survival (DSS)
• American Urological Association (AUA)
• National Comprehensive Cancer Network (NCCN)
• Relapse-free survival (RFS)
• Muscle-invasive bladder cancer (MIBC)

Despite standard treatment with transurethral resection (TUR) and adjuvant bacillus Calmette-Gu,rin (BCG), many high-risk bladder cancers (HRBCs) recur and some progress. Based on a review of the literature, we aimed to establish the optimal current approach for the early diagnosis and management of HRBC. %26lt;br%26gt;A MEDLINEA (R) search was conducted to identify the published literature relating to early identification and treatment for non-muscle-invasive bladder cancer. Particular attention was paid to factors such as quality of TUR, importance of second TUR, substaging, and CIS. In addition, studies on urinary markers, photodynamic diagnosis, predictive clinical and molecular factors for recurrence and progression after BCG, and best management practice were analysed. %26lt;br%26gt;Good quality of TUR and the implementation of photodynamic diagnosis in selected cases provide a more accurate diagnosis and reduce the risk of residual tumour in HRBC. Although insufficient evidence is available to warrant the use of new urinary molecular markers in isolation, their use in conjunction with cytology and cystoscopy may improve early diagnosis and follow-up. BCG plus maintenance for at least 1 year remains the standard adjuvant treatment for HRBC. Moreover, there is enough evidence to consider the implementation of new specific risk tables for patients treated with BCG. In HRBC patients with poor prognostic factors after TUR, early cystectomy should be considered.

• 出版日期2012-12