Tài liệu Report on The Management of Non-Muscle-Invasive Bladder Cancer ppt

Bladder Cancer Guidelines Panel

Report on Report on

The Management

Joseph A. Smith, Jr., MD, Chair

Richard F. Labasky, MD, Facilitator

James E. Montie, MD

Randall G. Rowland, MD

Abraham T.K. Cockett, MD

John A. Fracchia, MD

Members:

Consultants:

Hanan S. Bell, PhD

Patrick M. Florer

Curtis Colby

American

Urological

Association

Inc.,

Bladder Cancer Bladder Cancer Non-Muscle-Invasive of

(Stages Ta, T1 and Tis)

Archived Document—

For Reference Only

Bladder Cancer Clinical Guidelines Panel Members and Consultants

The Bladder Cancer Clinical Guidelines Panel consists of board-certified urologists who are experts in the treatment of blad￾der cancer. This Report on the Management of Non-Muscle-Invasive Bladder Cancer (stages Ta, T1 and Tis) was extensively

reviewed by over 50 physicians throughout the country in February 1999. The Panel finalized its recommendations for the

American Urological Association (AUA) Practice Parameters, Guidelines and Standards Committee, chaired by Joseph W.

Segura, MD, in July 1999. The AUA Board of Directors approved these practice guidelines in August 1999.

The Summary Report also underwent independent scrutiny by the Editorial Board of the Journal of Urology, was accepted

for publication in August 1999, and appeared in its November 1999 issue. A Doctor’s Guide for Patients and Evidence Working

Papers have also been developed; both are available from the AUA.

The AUA expresses its gratitude for the dedication and leadership demonstrated by the members of the Bladder Cancer

Clinical Guidelines Panel in producing this guideline.

Members Consultants

ISBN 0-9649702-5-2

Joseph A. Smith, Jr., M.D.

(Panel Chair)

Department Head

Department of Urology

Vanderbilt University Medical Center

Nashville, Tennessee

Richard F. Labasky, M.D.

(Panel Facilitator)

Assistant Professor

Division of Urology

University of Utah

Salt Lake City, Utah

James E. Montie, M.D.

Professor and Head

Section of Urology

University of Michigan

Ann Arbor, Michigan

Randall G. Rowland, M.D.

Professor and Director

Division of Urology

University of Kentucky

Chandler Medical Center

Lexington, Kentucky

Hanan S. Bell, Ph.D.

(Consultant in Methodology)

Seattle, Washington

Patrick M. Florer

(Database Design and

Coordination)

Dallas, Texas

Curtis Colby

(Editor)

Washington, D.C.

Residents (Data Extraction)

Jack Baniel

Elie Benaim

Clay Gould

Blake Hamilton

Jeff Holzbeierlien

Fred Leach

John Mansfield

Mitchell S. Steiner

Brad Stoneking

Joseph Trapasso

Margaret Wolf

Abraham T.K. Cockett, M.D.

(Physician Consultant)

Department of Urology

University of Rochester

Rochester, New York

John A. Fracchia, M.D.

(Physician Consultant)

Chief

Section of Urology

Department of Surgery

Lenox Hill Hospital

New York, New York

Archived Document—

For Reference Only

Copyright © 1999 American Urological Association, Inc. Page i

More than 50,000 new bladder cancer cases are diagnosed each year in the United States, and

the incidence rate (number of new cases per 100,000 persons per year) has been slowly rising, con￾current with an aging population (Landis, Murray, Bolden, et al., 1999; Parker, Tong, Bolden, et

al., 1996, 1997; Wingo, Tong, Bolden, et al., 1995).

Bladder cancer is largely a disease afflicting the late middle age and old age populations.

Although the disease does occur in young persons—even in children—more than 70 percent of

new cases are diagnosed in persons aged 65 and older (Lynch and Cohen, 1995; Yancik and Ries,

1994). As the baby boom generation ages over the next two decades, the incidence of bladder can￾cer will likely accelerate.

At any age, most bladder cancers, when initially diagnosed, have not invaded the detrusor mus￾cle (Fischer, Waechter, Kraus, et al., 1998; Fleshner, Herr, Stewart, et al. 1996). These noninvasive

cancers are the subject of this Report on the Management of Non-Muscle-Invasive Bladder Cancer

(Stages Ta, T1 and Tis). The report was produced by the American Urological Association's

Bladder Cancer Clinical Guidelines Panel.

The AUA charged the panel with the task of analyzing published outcomes data to assess po￾tential benefits and possible adverse effects of treatment interventions and to produce practice poli￾cy recommendations accordingly. The three types of outcomes the panel determined to be most

important for analysis are: 1) probability of tumor recurrence; 2) risk for tumor progression; and

3) complications of treatment.

The panel developed practice policy recommendations for three types of patients: 1) a patient

who presents with an abnormal growth on the urothelium, but who has not yet been diagnosed

with bladder cancer; 2) a patient with established bladder cancer of any grade, stage Ta or T1, with

or without carcinoma in situ (CIS), who has not had prior intravesical therapy; and 3) a patient

with CIS or high-grade T1 cancer who has had at least one course of intravesical therapy.

The panel avoided use of the term "superficial" in this report to categorize the three non-mus￾cle-invasive stages of bladder cancer: Ta, T1 and Tis. The panel agrees with the International

Society of Urological Pathology's recommendation that such use of the term should be discouraged

(Epstein, Amin, Reuter, et al., 1998). Ta, T1 and Tis tumors have often been grouped together as

"superficial" cancers because they are all superficial to the detrusor muscle, but in most other re￾spects they behave differently from one another and to group them in a single category is mislead￾ing. (See the discussion on page 16.)

A summary of this report has been published in the Journal of Urology (November 1999). A

Doctor's Guide for Patients and Evidence Working Papers are available for purchase through the

AUA.

Introduction

Archived Document—

For Reference Only

Archived Document—

For Reference Only

Copyright © 1999 American Urological Association, Inc. Page iii

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .i

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Treatment alternatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Treatment recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Chapter 1: Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Literature search, article selection and data extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Evidence combination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Chapter 2: Non-muscle-invasive bladder cancer and its management . . . . . . . . . . . . . . . . . . . . . . . . .13

Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Major types of bladder cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Histology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Staging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Grade classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Prognostic indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Treatment alternatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Follow-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Chapter 3: Outcomes analysis for treatments of non-muscle-invasive bladder cancer . . . . . . . . . . . . .21

The outcome tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Variability of outcomes data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Outcomes summary:recurrence and progression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Outcomes summary: treatment complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

Chapter 4: Recommendations for management of non-muscle-invasive bladder cancer . . . . . . . . . . . .28

Treatment policies: levels of flexibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Index patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Treatment recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

Areas for future research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

Appendix A – Data Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38

Appendix B – Data extraction form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54

Appendix C – Data analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

Contents

Archived Document—

For Reference Only

Managing Editor

Lisa Emmons

Graphic Desgner

Gary Weems

Copy Editor

Lisa Goetz

Copyright © 1999

American Urological Association, Inc.

Archived Document—

For Reference Only