Abstract：
OBJECTIVE: To update the CCAFU recommendations for the management of muscle invasive bladder carcinoma (MIBC).
METHODS: A systematic review (Medline) of the literature from 2020 to 2022 was performed taking account of the diagnosis, treatment options and surveillance of NMIBC and MIBC, while evaluating the references with their levels of evidence.
RESULTS: MIBC is diagnosed after the most complete tumour resection possible. MIBC grading is based on CTU along with chest CT. Multiparametric pelvic MRI could be an alternative. Cystectomy with extensive lymphadenectomy is the gold standard treatment for non-metastatic MIBC. It should be preceded by platinum-based neoadjuvant chemotherapy in patients in good general health with satisfactory renal function. Enterocystoplasty is proposed in men and women in the absence of contraindications and when the urethral resection is negative on extemporaneous examination. Otherwise, transileal cutaneous ureterostomy is the recommended method of urinary diversion. Inclusion of all patients in an ERAS (Enhanced Recovery After Surgery) protocol is recommended. For metastatic MIBC, first line treatment with platinum-based chemotherapy (GC or MVAC) is recommended, if general health (PS>1) and renal function (clearance>60mL/min) so allow (only 50% of the cases). Pembrolizumab immunotherapy has demonstrated an overall survival benefit in second-line treatment.
CONCLUSIONS: Updating the ccAFU recommendations should contribute to improving patient management, as well as the diagnosis and decision-making concerning MIBC treatment.
METHODS: A systematic review (Medline) of the literature from 2020 to 2022 was performed taking account of the diagnosis, treatment options and surveillance of NMIBC and MIBC, while evaluating the references with their levels of evidence.
RESULTS: MIBC is diagnosed after the most complete tumour resection possible. MIBC grading is based on CTU along with chest CT. Multiparametric pelvic MRI could be an alternative. Cystectomy with extensive lymphadenectomy is the gold standard treatment for non-metastatic MIBC. It should be preceded by platinum-based neoadjuvant chemotherapy in patients in good general health with satisfactory renal function. Enterocystoplasty is proposed in men and women in the absence of contraindications and when the urethral resection is negative on extemporaneous examination. Otherwise, transileal cutaneous ureterostomy is the recommended method of urinary diversion. Inclusion of all patients in an ERAS (Enhanced Recovery After Surgery) protocol is recommended. For metastatic MIBC, first line treatment with platinum-based chemotherapy (GC or MVAC) is recommended, if general health (PS>1) and renal function (clearance>60mL/min) so allow (only 50% of the cases). Pembrolizumab immunotherapy has demonstrated an overall survival benefit in second-line treatment.
CONCLUSIONS: Updating the ccAFU recommendations should contribute to improving patient management, as well as the diagnosis and decision-making concerning MIBC treatment.
摘要：
目的：更新CCAFU对肌层浸润性膀胱癌（MIBC）治疗的建议。
方法：对2020年至2022年的文献进行了系统评价（Medline），考虑到诊断，NMIBC和MIBC的治疗选择和监测，同时用证据水平评估参考文献。
结果：MIBC是在尽可能完整的肿瘤切除后诊断的。MIBC分级基于CTU和胸部CT。多参数骨盆MRI可能是一种替代方法。膀胱切除术和广泛的淋巴结清扫术是治疗非转移性MIBC的金标准。对于一般健康状况良好且肾功能满意的患者，应首先进行基于铂的新辅助化疗。在没有禁忌症的情况下，并且当尿道切除术在临时检查中呈阴性时，建议在男性和女性中进行肠细胞成形术。否则,经输尿管皮肤造口术是尿流改道的推荐方法。建议将所有患者纳入ERAS（手术后增强恢复）方案。对于转移性MIBC，建议使用铂类化疗（GC或MVAC）进行一线治疗，如果一般健康(PS>1)和肾功能(清除率>60mL/min)允许(只有50%的病例)。Pembrolizumab免疫治疗已证明在二线治疗中具有总体生存益处。
结论：更新ccAFU建议应有助于改善患者管理，以及有关MIBC治疗的诊断和决策。
方法：对2020年至2022年的文献进行了系统评价（Medline），考虑到诊断，NMIBC和MIBC的治疗选择和监测，同时用证据水平评估参考文献。
结果：MIBC是在尽可能完整的肿瘤切除后诊断的。MIBC分级基于CTU和胸部CT。多参数骨盆MRI可能是一种替代方法。膀胱切除术和广泛的淋巴结清扫术是治疗非转移性MIBC的金标准。对于一般健康状况良好且肾功能满意的患者，应首先进行基于铂的新辅助化疗。在没有禁忌症的情况下，并且当尿道切除术在临时检查中呈阴性时，建议在男性和女性中进行肠细胞成形术。否则,经输尿管皮肤造口术是尿流改道的推荐方法。建议将所有患者纳入ERAS（手术后增强恢复）方案。对于转移性MIBC，建议使用铂类化疗（GC或MVAC）进行一线治疗，如果一般健康(PS>1)和肾功能(清除率>60mL/min)允许(只有50%的病例)。Pembrolizumab免疫治疗已证明在二线治疗中具有总体生存益处。
结论：更新ccAFU建议应有助于改善患者管理，以及有关MIBC治疗的诊断和决策。
