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Abstract：
BACKGROUND: The first European Association of Urology (EAU) guidelines on bladder cancer were published in 2002 [1]. Since then, the guidelines have been continuously updated.
OBJECTIVE: To present the 2013 EAU guidelines on non-muscle-invasive bladder cancer (NMIBC).
METHODS: Literature published between 2010 and 2012 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the levels of evidence and grades of recommendation were assigned.
RESULTS: Tumours staged as Ta, T1, or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection (TUR) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TUR is essential for the patient\'s prognosis. Where the initial resection is incomplete, where there is no muscle in the specimen, or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk. The risks of both recurrence and progression may be estimated for individual patients using the EORTC scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups is pivotal to recommending adjuvant treatment. For patients with a low-risk tumour, one immediate instillation of chemotherapy is recommended. Patients with an intermediate-risk tumour should receive one immediate instillation of chemotherapy followed by 1 yr of full-dose bacillus Calmette-Guérin (BCG) intravesical immunotherapy or by further instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. In patients at highest risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is recommended in BCG-refractory tumours. The long version of the guidelines is available from the EAU Web site: http://www.uroweb.org/guidelines/.
CONCLUSIONS: These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.
RESULTS: The EAU Panel on Non-muscle Invasive Bladder Cancer released an updated version of their guidelines. Current clinical studies support patient selection into different risk groups; low, intermediate and high risk. These risk groups indicate the likelihood of the development of a new (recurrent) cancer after initial treatment (endoscopic resection) or progression to more aggressive (muscle-invasive) bladder cancer and are most important for the decision to provide chemo- or immunotherapy (bladder installations). Surgical removal of the bladder (radical cystectomy) should only be considered in patients who have failed chemo- or immunotherapy, or who are in the highest risk group for progression.
OBJECTIVE: To present the 2013 EAU guidelines on non-muscle-invasive bladder cancer (NMIBC).
METHODS: Literature published between 2010 and 2012 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the levels of evidence and grades of recommendation were assigned.
RESULTS: Tumours staged as Ta, T1, or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection (TUR) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TUR is essential for the patient\'s prognosis. Where the initial resection is incomplete, where there is no muscle in the specimen, or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk. The risks of both recurrence and progression may be estimated for individual patients using the EORTC scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups is pivotal to recommending adjuvant treatment. For patients with a low-risk tumour, one immediate instillation of chemotherapy is recommended. Patients with an intermediate-risk tumour should receive one immediate instillation of chemotherapy followed by 1 yr of full-dose bacillus Calmette-Guérin (BCG) intravesical immunotherapy or by further instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. In patients at highest risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is recommended in BCG-refractory tumours. The long version of the guidelines is available from the EAU Web site: http://www.uroweb.org/guidelines/.
CONCLUSIONS: These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.
RESULTS: The EAU Panel on Non-muscle Invasive Bladder Cancer released an updated version of their guidelines. Current clinical studies support patient selection into different risk groups; low, intermediate and high risk. These risk groups indicate the likelihood of the development of a new (recurrent) cancer after initial treatment (endoscopic resection) or progression to more aggressive (muscle-invasive) bladder cancer and are most important for the decision to provide chemo- or immunotherapy (bladder installations). Surgical removal of the bladder (radical cystectomy) should only be considered in patients who have failed chemo- or immunotherapy, or who are in the highest risk group for progression.
摘要：
背景：第一个关于膀胱癌的欧洲泌尿外科协会（EAU）指南于2002年发表[1]。从那以后,准则不断更新。
目的：介绍2013年EAU关于非肌层浸润性膀胱癌（NMIBC）的指南。
方法：系统回顾了2010-2012年间发表的关于NMIBC诊断和治疗的文献。以前的指南已更新，并分配了证据水平和推荐等级。
结果：肿瘤表现为Ta，T1或原位癌(CIS)被分组为NMIBC。诊断取决于膀胱镜检查和对乳头状肿瘤的经尿道电切术（TUR）或CI中的多次膀胱活检获得的组织的组织学评估。在乳头状病变中，完整的TUR对患者的预后至关重要。在最初切除不完整的地方，样本中没有肌肉的地方，或者检测到高级别或T1肿瘤，第二次TUR应在2-6周内进行。可以使用EORTC评分系统和风险表估计个体患者的复发和进展的风险。将患者分层为低，中介-，高危人群是推荐辅助治疗的关键。对于患有低风险肿瘤的患者，建议立即滴注化疗。中危肿瘤患者应立即滴注化疗，然后进行1年的全剂量卡介苗（BCG）膀胱内免疫治疗，或进一步滴注化疗，最长1年。在高危肿瘤患者中，显示1-3年的全剂量膀胱内BCG。在肿瘤进展风险最高的患者中，应考虑立即行根治性膀胱切除术。BCG难治性肿瘤建议行膀胱切除术。指南的长版可从EAU网站获得：http://www。uroweb.org/guidelines/。
结论：这些简化的EAU指南提供了有关NMIBC诊断和治疗的最新信息，以纳入临床实践。
结果：非肌肉浸润性膀胱癌EAU小组发布了其指南的更新版本。当前的临床研究支持将患者选择为不同的风险组；低，中等和高风险。这些风险组表明在初始治疗（内窥镜切除术）或进展为更具侵袭性（肌肉浸润性）膀胱癌后发展为新的（复发性）癌症的可能性，并且对于提供化学疗法或免疫疗法的决定最重要（膀胱装置）。手术切除膀胱（根治性膀胱切除术）只能在化疗或免疫治疗失败的患者中考虑。或处于进展的最高风险组。
目的：介绍2013年EAU关于非肌层浸润性膀胱癌（NMIBC）的指南。
方法：系统回顾了2010-2012年间发表的关于NMIBC诊断和治疗的文献。以前的指南已更新，并分配了证据水平和推荐等级。
结果：肿瘤表现为Ta，T1或原位癌(CIS)被分组为NMIBC。诊断取决于膀胱镜检查和对乳头状肿瘤的经尿道电切术（TUR）或CI中的多次膀胱活检获得的组织的组织学评估。在乳头状病变中，完整的TUR对患者的预后至关重要。在最初切除不完整的地方，样本中没有肌肉的地方，或者检测到高级别或T1肿瘤，第二次TUR应在2-6周内进行。可以使用EORTC评分系统和风险表估计个体患者的复发和进展的风险。将患者分层为低，中介-，高危人群是推荐辅助治疗的关键。对于患有低风险肿瘤的患者，建议立即滴注化疗。中危肿瘤患者应立即滴注化疗，然后进行1年的全剂量卡介苗（BCG）膀胱内免疫治疗，或进一步滴注化疗，最长1年。在高危肿瘤患者中，显示1-3年的全剂量膀胱内BCG。在肿瘤进展风险最高的患者中，应考虑立即行根治性膀胱切除术。BCG难治性肿瘤建议行膀胱切除术。指南的长版可从EAU网站获得：http://www。uroweb.org/guidelines/。
结论：这些简化的EAU指南提供了有关NMIBC诊断和治疗的最新信息，以纳入临床实践。
结果：非肌肉浸润性膀胱癌EAU小组发布了其指南的更新版本。当前的临床研究支持将患者选择为不同的风险组；低，中等和高风险。这些风险组表明在初始治疗（内窥镜切除术）或进展为更具侵袭性（肌肉浸润性）膀胱癌后发展为新的（复发性）癌症的可能性，并且对于提供化学疗法或免疫疗法的决定最重要（膀胱装置）。手术切除膀胱（根治性膀胱切除术）只能在化疗或免疫治疗失败的患者中考虑。或处于进展的最高风险组。
