Although associated with an overall favorable survival rate, the heterogeneity of non-muscle invasive bladder cancer (NMIBC) affects patients' rates of recurrence and progression. Risk stratification should influence evaluation, treatment and surveillance.
This guideline attempts to provide a clinical framework for the management of NMIBC.
A systematic review utilized research from the Agency for Healthcare Research and Quality (AHRQ) and additional supplementation by the authors and consultant methodologists. Evidence-based statements were based on body of evidence strength Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions.1 ( Table 1) RESULTS: A risk-stratified approach categorizes patients into broad groups of low-, intermediate-, and high-risk. Importantly, the evaluation and treatment algorithm takes into account tumor characteristics and uniquely considers a patient's response to therapy. (Figure 1) The 38 statements vary in level of evidence, but none include Grade A evidence, and many were Grade C.
The intensity and scope of care for NMIBC should focus on patient, disease, and treatment response characteristics. This guideline attempts to improve a clinician's ability to evaluate and treat each patient, but higher quality evidence in future trials will be essential to improve level of care for these patients.
The Journal of urology. 2016 Jun 15 [Epub ahead of print]
Sam S Chang, Stephen A Boorjian, Roger Chou, Peter E Clark, Siamak Daneshmand, Erin Kirkby, Badrinath R Konety, Raj Pruthi, Diane Z Quale, Chad R Ritch, John D Seigne, Eila Curlee Skinner, Norm D Smith, James M McKiernan