中等风险（IR）非肌肉浸润性膀胱癌（NMIBC）是一种异质性疾病。
更新国际膀胱癌组织（IBCG）的指南，并提供有关IRNMIBC管理的实用建议。
对已发表的随机临床试验的合作回顾，荟萃分析，系统评价,2022年1月之前发布的关于IRNMIBC的临床实践指南是使用PubMed/Medline进行的。
定义IRNMIBC的准则之间存在差异。IBCG建议将IRNMIBC定义为任何复发性或多灶性或大小≥3cm的TaLG肿瘤，或任何T1LG肿瘤。如果使用3层分级系统，与任何TaG2肿瘤相比，也将被认为是IR疾病，无论新诊断还是复发。肿瘤的准确分级和分期，特别是排除HG/G3疾病和/或原位癌，是至关重要的。IBCG建议IRNMIBC的管理应进一步基于以下风险因素：多灶性肿瘤（多于一个），早期复发（<1年），频繁复发（>1/年），肿瘤大小（≥3厘米），和先前膀胱内治疗失败。没有危险因素的患者最好通过一次剂量的术后膀胱内化疗来管理。具有一到两个危险因素的患者应接受额外的辅助诱导膀胱内化疗（如果先前使用过化疗，则为卡介苗（BCG））。具有三个或更多危险因素的患者应提供诱导加1年的维持BCG。如果卡介苗不可用或卡介苗后出现复发性疾病，替代膀胱内治疗，如化疗(单药，组合,或化学热疗）或建议进行临床试验。
标准化IRNMIBC的定义对于患者的适当管理和允许跨临床试验的结果比较至关重要。IBCG建议将IRNMIBC定义为任何复发或多灶性或≥3cm的TaLG肿瘤，或任何T1LG肿瘤。如果使用3层分级系统，与任何TaG2肿瘤相比，也将被认为是IR疾病，无论是否新诊断或复发。辅助管理应基于既定的风险因素。
标准化中等风险（IR）非肌肉浸润性膀胱癌（NMIBC）的定义，这是一种异质性疾病，对于患者的适当管理至关重要。国际膀胱癌组织建议根据以下危险因素对IRNMIBC肿瘤进行分类和个性化管理：多灶性肿瘤（多灶性肿瘤），早期复发（<1年），频繁复发（>1/年），肿瘤大小（≥3厘米），和以前的膀胱内治疗。
Intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC) is a heterogeneous disease.
To update the International Bladder Cancer Group (IBCG) guidance and provide practical recommendations on IR NMIBC management.
A collaborative review of published randomized clinical trials, meta-analyses, systematic reviews, and clinical practice guidance on IR NMIBC published before January 2022 was undertaken using PubMed/Medline.
Variation exists between
guidelines in defining IR NMIBC. The IBCG recommends defining IR NMIBC as any TaLG tumor that is either recurrent or multifocal or has size ≥3 cm, OR any T1LG tumor. If the 3 tier grading system is used, than any TaG2 tumor would also be considered IR diease regardless of whether new diagnosis or recurrent. Accurate grading and staging of tumor, particularly in ruling out HG/G3 disease and/or carcinoma in situ, are crucial. The IBCG recommends that management of IR NMIBC should be further based on the following risk factors: multifocal tumor (more than one), early recurrence (<1 yr), frequent recurrence (>1/yr), tumor size (≥3 cm), and failure of prior
intravesical treatment. Patients with no risk factors are best managed by one dose of postoperative
intravesical chemotherapy. Patients with one to two risk factors should be offered additional adjuvant induction
intravesical chemotherapy (or bacillus Calmette-Guérin (BCG) if prior chemotherapy has been used). Patients with three or more risk factors should be offered induction plus 1-yr maintenance BCG. Where BCG is not available or recurrent disease following BCG is present, alternative
intravesical treatments such as chemotherapy (single agent, combination, or chemohyperthermia) or a clinical trial are recommended.
Standardizing the definition of IR NMIBC is critical for appropriate management of patients and for allowing a comparison of outcomes across clinical trials. The IBCG recommends defining IR NMIBC as any TaLG tumor that is either recurrent or multifocal or ≥3 cm, OR any T1LG tumor. If the 3 tier grading system is used, than any TaG2 tumor would also be considered IR disease regardless of whether new diagnosis or recurrent. Adjunctive management should then be based on established risk factors.
Standardizing the definition of intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC), which is a heterogeneous disease, is critical for appropriate management of patients. The International Bladder Cancer Group recommends classification of IR NMIBC tumors and personalized management based on the following risk factors: multifocal tumor (more than one), early recurrence (<1 yr), frequent recurrence (>1/yr), tumor size (≥3 cm), and previous intravesical treatment.
