PURPOSE: 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.(1) 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.
PURPOSE: 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.(1) 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.
Authors: Jean Carlo F Datovo; Wilmar Azal Neto; Gustavo B Mendonça; Danilo L Andrade; Leonardo O Reis Journal: World J Urol Date: 2019-02-25 Impact factor: 4.226
Authors: Eva Compérat; Marek Babjuk; Ferran Algaba; Mahul Amin; Fadi Brimo; David Grignon; Donna Hansel; Ondra Hes; Bernard Malavaud; Victor Reuter; Theo van der Kwast Journal: World J Urol Date: 2018-09-14 Impact factor: 4.226
Authors: Mandy L Y Sin; Kathleen E Mach; Rahul Sinha; Fan Wu; Dharati R Trivedi; Emanuela Altobelli; Kristin C Jensen; Debashis Sahoo; Ying Lu; Joseph C Liao Journal: Clin Cancer Res Date: 2017-02-13 Impact factor: 12.531
Authors: Kevin Koo; Lisa Zubkoff; Brenda E Sirovich; Philip P Goodney; Douglas J Robertson; John D Seigne; Florian R Schroeck Journal: Urology Date: 2017-07-21 Impact factor: 2.649
Authors: Devon K Check; David S Aaronson; Matthew E Nielsen; Valerie S Lee; Isaac J Ergas; Janise M Roh; Lawrence H Kushi; Li Tang; Marilyn L Kwan Journal: Urology Date: 2018-10-23 Impact factor: 2.649