目的:膀胱癌指南国家委员会CCAFU的目的是提出针对非肌肉浸润性(NMIBC)和浸润性(MIBC)膀胱癌的最新法国指南。
方法:在2013年至2016年之间进行了Medline搜索,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)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的扩展评估基于骨盆腹部和胸部CT扫描;MRI和FDG-PET仍然是可选的。与广泛的盆腔淋巴结切除术相关的膀胱切除术被认为是非转移性MIBC的金标准。对于没有任何禁忌症的男性和女性患者以及冷冻尿道样本阴性的患者,应建议进行原位膀胱置换。新辅助化疗的兴趣在所有MIBC中都是众所周知的,在舞台上摇摆。因此,根据PS(PS<2)和肾功能(清除率>60ml/mn),所有符合条件的患者都推荐新辅助化疗。至于转移性MIBC,推荐使用铂的一线化疗(GC或MVAC).在二线治疗中,迄今为止,只有使用长春氟宁的化疗得到了验证,即使免疫治疗临床试验的结果令人鼓舞。
结论:这些更新的法国指南将有助于提高NMIBC和MIBC诊断和治疗的泌尿外科护理水平。©2016ElsevierMassonSAS。保留所有权利。
OBJECTIVE: The purpose of the
guidelines national committee CCAFU on bladder cancer was to propose updated french
guidelines for non-muscle invasive (NMIBC) and invasive (MIBC) bladder cancers.
METHODS: A Medline search was achieved between 2013 and 2016, as regards 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 tumour. 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 pelvic-abdominal and thoracic CT-scan; MRI and FDG-PET remain optional. Cystectomy associated with extensive pelvic lymph nodes resection is considered the gold standard for non metastatic MIBC. An orthotopic bladder substitution should be proposed to both male and female patients lacking any contraindications and in cases of negative frozen urethral samples. The interest of neoadjuvant chemotherapy is well known for all MIBC, wathever the stage. Thus, neoadjuvant chemotherapy is recommended for all eligible patients according PS (PS <2) and renal function (clearance > 60ml/mn). As regards metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC). In second line treatment, only chemotherapy using vinflunine has been validated to date, even if results of immunotherapy clinical trials are encouraging.
CONCLUSIONS: These updated french
guidelines will contribute to increase the level of urological care for the diagnosis and treatment for NMIBC and MIBC. © 2016 Elsevier Masson SAS. All rights reserved.