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Jin YH, Zeng XT, Liu TZ, Bai ZM, Dou ZL, Ding DG, Fan ZL, Han P, Huang YR, Huang X, Li M, Li XD, Li YN, Li XH, Liang CZ, Liu JM, Ma HS, Qi J, Shi JQ, Wang J, Wang DL, Wang ZP, Wang YY, Wang YB, Wei Q, Xia HB, Xing JC, Yan SY, Zhang XP, Zheng GY, Xing NZ, He DL, Wang XH. Treatment and surveillance for non-muscle-invasive bladder cancer: a clinical practice guideline (2021 edition). Mil Med Res 2022; 9:44. [PMID: 35978389 PMCID: PMC9382792 DOI: 10.1186/s40779-022-00406-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
Non-muscle invasive bladder cancer (NMIBC) is a major type of bladder cancer with a high incidence worldwide, resulting in a great disease burden. Treatment and surveillance are the most important part of NIMBC management. In 2018, we issued "Treatment and surveillance for non-muscle-invasive bladder cancer in China: an evidence-based clinical practice guideline". Since then, various studies on the treatment and surveillance of NMIBC have been published. There is a need to incorporate these materials and also to take into account the relatively limited medical resources in primary medical institutions in China. Developing a version of guideline which takes these two issues into account to promote the management of NMIBC is therefore indicated. We formed a working group of clinical experts and methodologists. Through questionnaire investigation of clinicians including primary medical institutions, 24 clinically concerned issues, involving transurethral resection of bladder tumor (TURBT), intravesical chemotherapy and intravesical immunotherapy of NMIBC, and follow-up and surveillance of the NMIBC patients, were determined for this guideline. Researches and recommendations on the management of NMIBC in databases, guideline development professional societies and monographs were referred to, and the European Association of Urology was used to assess the certainty of generated recommendations. Finally, we issued 29 statements, among which 22 were strong recommendations, and 7 were weak recommendations. These recommendations cover the topics of TURBT, postoperative chemotherapy after TURBT, Bacillus Calmette-Guérin (BCG) immunotherapy after TURBT, combination treatment of BCG and chemotherapy after TURBT, treatment of carcinoma in situ, radical cystectomy, treatment of NMIBC recurrence, and follow-up and surveillance. We hope these recommendations can help promote the treatment and surveillance of NMIBC in China, especially for the primary medical institutions.
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Affiliation(s)
- Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Tong-Zu Liu
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Zhi-Ming Bai
- Department of Urology, Haikou People’s Hospital, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou, 570208 China
| | - Zhong-Ling Dou
- Department of Urology, the First Affiliated Hospital and College of Clinical Medicine, Henan University of Science and Technology, Luoyang, 450052 Henan China
| | - De-Gang Ding
- Department of Urology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, 450003 China
| | - Zhi-Lu Fan
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, 116023 Liaoning China
| | - Ping Han
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Yi-Ran Huang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200120 China
| | - Xing Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Ming Li
- Department of Urology, the People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830002 China
| | - Xiao-Dong Li
- Department of Urology, Huaihe Hospital of Henan University, Kaifeng, 475000 Henan China
- Institutes of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000 Henan China
| | - Yi-Ning Li
- Department of Urology, the Second Affiliated Hospital and Second Clinical Medical College of Fujian Medical University, Quanzhou, 362000 Fujian China
| | - Xu-Hui Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Chao-Zhao Liang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Jiu-Min Liu
- Department of Urology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080 China
| | - Hong-Shun Ma
- Department of Urology, Tianjin First Central Hospital, Tianjin, 300190 China
| | - Juan Qi
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092 China
| | - Jia-Qi Shi
- Department of Urology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004 China
| | - Jian Wang
- Department of Urology, Qinghai University Affiliated Hospital, Xining, 810012 China
| | - De-Lin Wang
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
| | - Zhi-Ping Wang
- Department of Urology, Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases in Gansu Province, Lanzhou, 730030 China
| | - Yun-Yun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Yong-Bo Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Hai-Bo Xia
- Department of Urology, Chifeng Cancer Hospital, the Second Affiliated Hospital of Chifeng University, Chifeng, 024000 Inner Mongolia Autonomous Region China
| | - Jin-Chun Xing
- Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology, the First Affiliated Hospital of Xiamen University, Xiamen, 361003 China
| | - Si-Yu Yan
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Xue-Pei Zhang
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Guo-You Zheng
- Department of Urology, the Second Division of the First Hospital of Jilin University, Changchun, 130061 China
| | - Nian-Zeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Da-Lin He
- Department of Urology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
| | - Xing-Huan Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - the Chinese Urological Doctor Association (CUDA), Urological Association of Chinese Research Hospital Association (CRHA-UA), Uro-Health Promotive Association of China International Exchange, Promotive Association for Medical, Health Care (CPAM-UHPA)
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
- Department of Urology, Haikou People’s Hospital, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou, 570208 China
- Department of Urology, the First Affiliated Hospital and College of Clinical Medicine, Henan University of Science and Technology, Luoyang, 450052 Henan China
- Department of Urology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, 450003 China
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, 116023 Liaoning China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041 China
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200120 China
- Department of Urology, the People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830002 China
- Department of Urology, Huaihe Hospital of Henan University, Kaifeng, 475000 Henan China
- Institutes of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000 Henan China
- Department of Urology, the Second Affiliated Hospital and Second Clinical Medical College of Fujian Medical University, Quanzhou, 362000 Fujian China
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
- Department of Urology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080 China
- Department of Urology, Tianjin First Central Hospital, Tianjin, 300190 China
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092 China
- Department of Urology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004 China
- Department of Urology, Qinghai University Affiliated Hospital, Xining, 810012 China
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
- Department of Urology, Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases in Gansu Province, Lanzhou, 730030 China
- Department of Urology, Chifeng Cancer Hospital, the Second Affiliated Hospital of Chifeng University, Chifeng, 024000 Inner Mongolia Autonomous Region China
- Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology, the First Affiliated Hospital of Xiamen University, Xiamen, 361003 China
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
- Department of Urology, the Second Division of the First Hospital of Jilin University, Changchun, 130061 China
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
- Department of Urology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
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Caputo JM, Moran G, Muller B, Keller AT, Li G, Anderson CB. The Management of Newly-Diagnosed Non-muscle Invasive Bladder Cancer in Veterans Integrated Services Network 02 of the Veterans Health Administration. Mil Med 2021; 185:276-281. [PMID: 31294791 DOI: 10.1093/milmed/usz166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/04/2019] [Accepted: 06/12/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Over 1,500 bladder cancers were diagnosed among US Veterans in 2010, the majority of which were non-muscle invasive bladder cancer (NMIBC). Little is known about NMIBC treatment within the Veterans Health Administration. The objective of the study was to assess the quality of care for Veterans with newly-diagnosed NMIBC within Veterans Integrated Service Network (VISN) 02. MATERIALS AND METHODS We used ICD-9 and ICD-10 codes to identify patients with newly-diagnosed bladder cancer from 1/2016-8/2017. We risk-stratified the patients into low, intermediate, and high-risk based on the 2016 American Urological Association Guidelines on NMIBC. Our primary objectives were percentages of transurethral resection of bladder tumors (TURBTs) with detrusor, repeat TURBT in high-risk and T1 disease, high-risk NMIBC treated with induction intravesical therapy (IVT), and responders treated with maintenance IVT. We performed logistic regression for association between distance to diagnosing hospital and receipt of induction IVT in high-risk patients. RESULTS There were 121 newly-diagnosed NMIBC patients; 16% low-risk, 28% intermediate-risk, and 56% high-risk. Detrusor was present in 80% of all initial TURBTs and 84% of high-risk patients. Repeat TURBT was performed in 56% of high-risk NMIBC and 60% of T1. Induction IVT was given to 66% of high-risk patients and maintenance IVT was given to 59% of responders. On multivariate logistic regression, distance to medical center was not associated with receipt of induction IVT (OR = 0.99, 95% CI [0.97,1.01], p = 0.52). CONCLUSIONS We observed high rates of sampling of detrusor in the first TURBT specimen, utilization of repeat TURBT, and administration of induction and maintenance intravesical BCG for high-risk patients among a regional cohort of US Veterans with NMIBC. While not a comparative study, our findings suggest high quality NMIBC care in VA VISN 02.
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Affiliation(s)
- Joseph M Caputo
- Department of Urology, NewYork-Presbyterian/Columbia University Medical Center, 161 Fort Washington Avenue 11th Floor, New York, NY 10032.,James J. Peters Veterans Affairs Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468
| | - George Moran
- Department of Urology, NewYork-Presbyterian/Columbia University Medical Center, 161 Fort Washington Avenue 11th Floor, New York, NY 10032
| | - Benjamin Muller
- Department of Urology, NewYork-Presbyterian/Columbia University Medical Center, 161 Fort Washington Avenue 11th Floor, New York, NY 10032
| | - Alison T Keller
- James J. Peters Veterans Affairs Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468
| | - Gen Li
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th St, New York, NY 10032
| | - Christopher B Anderson
- Department of Urology, NewYork-Presbyterian/Columbia University Medical Center, 161 Fort Washington Avenue 11th Floor, New York, NY 10032.,James J. Peters Veterans Affairs Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468
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