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Abstract：
OBJECTIVE: - To update French guidelines for the management of bladder cancer specifically non-muscle invasive (NMIBC) and muscle-invasive bladder cancers (MIBC).
METHODS: - A Medline search was achieved between 2018 and 2020, notably regarding diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence.
RESULTS: - Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS <1) and renal function (creatinine clearance >60 mL/min) allow it (only in 50% of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival.
CONCLUSIONS: - These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment of patients diagnosed with NMIBC and MIBC.
METHODS: - A Medline search was achieved between 2018 and 2020, notably regarding diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence.
RESULTS: - Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS <1) and renal function (creatinine clearance >60 mL/min) allow it (only in 50% of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival.
CONCLUSIONS: - These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment of patients diagnosed with NMIBC and MIBC.
摘要：
目的：-更新法国膀胱癌特别是非肌肉浸润性（NMIBC）和肌肉浸润性膀胱癌（MIBC）的治疗指南。
方法：-在2018年至2020年之间进行了Medline搜索，特别是在诊断方面，膀胱癌的治疗和随访选择，用证据水平评估不同的参考文献。
结果：-NMIBC的诊断（Ta，T1，CIS）是基于对肿瘤的完全深度切除。使用荧光和二次指征对于改善初始诊断至关重要。复发和进展的风险可以使用EORTC评分来估计。将患者分层为低，中危和高危人群是推荐辅助治疗的关键:化疗滴注(术后立即，标准时间表）或膀胱内BCG（标准时间表和维护）。BCG难治性患者建议行膀胱切除术。MIBC的扩展评估基于对比增强的骨盆腹部和胸部CT扫描。多参数MRI可以是替代方案。与扩大淋巴结清扫术相关的膀胱切除术被认为是非转移性MIBC的金标准。在符合条件的患者中，应先进行基于顺铂的新辅助化疗。对于没有禁忌症的男性和女性患者，以及在冷冻尿道样本阴性的情况下，都应建议进行原位膀胱置换；否则，建议将尿道输尿管造口术作为尿流改道。所有患者均应纳入手术后早期恢复（ERAS）方案。对于转移性MIBC，推荐使用铂的一线化疗（GC或MVAC），当表现状态（PS<1）和肾功能（肌酐清除率>60mL/min）允许时（仅在50％的病例中）。在二线治疗中，pembrolizumab的免疫疗法显示了总生存期的显著改善.
结论：-这些更新的法国指南将有助于提高诊断为NMIBC和MIBC的患者的泌尿外科护理水平。
方法：-在2018年至2020年之间进行了Medline搜索，特别是在诊断方面，膀胱癌的治疗和随访选择，用证据水平评估不同的参考文献。
结果：-NMIBC的诊断（Ta，T1，CIS）是基于对肿瘤的完全深度切除。使用荧光和二次指征对于改善初始诊断至关重要。复发和进展的风险可以使用EORTC评分来估计。将患者分层为低，中危和高危人群是推荐辅助治疗的关键:化疗滴注(术后立即，标准时间表）或膀胱内BCG（标准时间表和维护）。BCG难治性患者建议行膀胱切除术。MIBC的扩展评估基于对比增强的骨盆腹部和胸部CT扫描。多参数MRI可以是替代方案。与扩大淋巴结清扫术相关的膀胱切除术被认为是非转移性MIBC的金标准。在符合条件的患者中，应先进行基于顺铂的新辅助化疗。对于没有禁忌症的男性和女性患者，以及在冷冻尿道样本阴性的情况下，都应建议进行原位膀胱置换；否则，建议将尿道输尿管造口术作为尿流改道。所有患者均应纳入手术后早期恢复（ERAS）方案。对于转移性MIBC，推荐使用铂的一线化疗（GC或MVAC），当表现状态（PS<1）和肾功能（肌酐清除率>60mL/min）允许时（仅在50％的病例中）。在二线治疗中，pembrolizumab的免疫疗法显示了总生存期的显著改善.
结论：-这些更新的法国指南将有助于提高诊断为NMIBC和MIBC的患者的泌尿外科护理水平。
