Recent Advances in the Management of Patients with Non-Muscle-Invasive Bladder Cancer Using a Multidisciplinary Approach: Practical Recommendations from the Spanish Oncology Genitourinary (SOGUG) Working Group

Abstract

On the basis of the discussion of the current state of research on relevant topics of non-muscle-invasive bladder cancer (NMIBC) among a group of experts of the Spanish Oncology Genitourinary (SOGUG) Working Group, recommendations were proposed to overcome the challenges posed by the management of NMIBC in clinical practice. A unified definition of the term ‘microhematuria’ and the profile of the patient at risk are needed. Establishing a ‘hematuria clinic’ would contribute to a centralized and more efficient evaluation of patients with this clinical sign. Second or repeated transurethral resection (re-TUR) needs to be defined, including the time window after the first procedure within which re-TUR should be performed. Complete tumor resection is mandatory when feasible, with specification of the presence or absence of muscle. Budding should be used as a classification system, and stratification of T1 tumors especially in extensive and deep tumors, is advisable. The percentage of the high-grade component should always be reported, and, in multiple tumors, grades should be reported separately. Luminal and basal subtypes can be identified because of possibly different clinical outcomes. Molecular subtypes and immunotherapy are incorporated in the management of muscle-invasive bladder cancer but data on NMIBC are still preliminary.

A Systematic Review on the Role of Repeat Transurethral Resection after Initial en Bloc Resection for Non-Muscle Invasive Bladder Cancer

“…The pooled RR were 1.10 (95%CI: 1.01 × 10 1. 19 ) and 1.15 (95%CI: 1.03-1.28), respectively [44]. While reTURB did not improve long-term RFS (5-year, 10-year, 15-year) in T1 patients.…”

“…An early reTURB is recommended to be performed for selected patients by all the most followed international guidelines in the urological community ( Table 1 ) [ 3 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Compared with initial TURB, reTURB can remove the residual tumors, detect understaging BC, improve the responsive rate of intravesical Bacillus Calmette-Guerin (BCG) instillation, and instruct further treatments [ 16 , 17 , 18 , 19 ]. A recent study corroborated the important role of routine reTURB, followed by an adequate maintenance course of BCG in organ-sparing NMIBC patients [ 20 ].…”

Establishment and validation of nomograms to predict the overall survival and cancer-specific survival for non-metastatic bladder cancer patients: A large population-based cohort study and external validation

“…Grade is clinically relevant to the patient prognosis, but different clinical guidelines recommend different pathological reports according to the 1973 or 2004/2016 WHO grading systems, with G1-G3 or low-grade (LG), high-grade (HG) and the category of papillary urothelial neoplasms of low malignant potential (PUNLMP), which may bias our analysis. [ 45 ] This may explain why patients at grade III and patients at grade IV rank similarly in nomograms. T stage has great weight in our models.…”

Molecular Oncology of Bladder Cancer from Inception to Modern Perspective

“…Bladder cancer (BC) is a common cancer in the United States with high morbidity and mortality among affected patients [ 1 , 2 , 3 ]. Since the first true description of BC almost 200 years ago, the diagnosis and management of BC have significantly evolved [ 4 ].…”