EAU Guidelines on Non–Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2013

Babjuk, Marko; Burger, Maximilian; Zigeuner, Richard; Shariat, Shahrokh F.; van Rhijn, Bas W.G.; Compérat, Eva; Sylvester, Richard J.; Kaasinen, Eero; Böhle, Andreas; Palou Redorta, Joan; Rouprêt, Morgan

doi:10.1016/j.eururo.2013.06.003

Cited by 1,174Bladder and Urothelial Cancer TreatmentsUrinary Bladder and Prostate ResearchUrinary and Genital Oncology Studies

EAU Guidelines on Non–Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2013

Babjuk, Marko, Burger, Maximilian, Zigeuner, Richard, Shariat, Shahrokh F., van Rhijn, Bas W.G., Compérat, Eva, Sylvester, Richard J., Kaasinen, Eero +3 more·2013·European Urology

DOI 10.1016/j.eururo.2013.06.003

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Abstract

Context The first European Association of Urology (EAU) guidelines on bladder cancer were published in 2002 [1]. Since then, the guidelines have been continuously updated. Objective To present the 2013 EAU guidelines on non-muscle-invasive bladder cancer (NMIBC). Evidence acquisition Literature published between 2010 and 2012 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the levels of evidence and grades of recommendation were assigned. Evidence synthesis Tumours staged as Ta, T1, or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection (TUR) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TUR is essential for the patient's prognosis. Where the initial resection is incomplete, where there is no muscle in the specimen, or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk. The risks of both recurrence and progression may be estimated for individual patients using the EORTC scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups is pivotal to recommending adjuvant treatment. For patients with a low-risk tumour, one immediate instillation of chemotherapy is recommended. Patients with an intermediate-risk tumour should receive one immediate instillation of chemotherapy followed by 1 yr of full-dose bacillus Calmette-Guérin (BCG) intravesical immunotherapy or by further instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. In patients at highest risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is recommended in BCG-refractory tumours. The long version of the guidelines is available from the EAU Web site: http://www.uroweb.org/guidelines/. Conclusions These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice. Patient summary The EAU Panel on Non-muscle Invasive Bladder Cancer released an updated version of their guidelines. Current clinical studies support patient selection into different risk groups; low, intermediate and high risk. These risk groups indicate the likelihood of the development of a new (recurrent) cancer after initial treatment (endoscopic resection) or progression to more aggressive (muscle-invasive) bladder cancer and are most important for the decision to provide chemo- or immunotherapy (bladder installations). Surgical removal of the bladder (radical cystectomy) should only be considered in patients who have failed chemo- or immunotherapy, or who are in the highest risk group for progression.

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Authors: Babjuk, M., Burger, M., Zigeuner, R., Shariat, S. F., van Rhijn, B. W. G., Compérat, E., Sylvester, R. J., Kaasinen, E., Böhle, A., Palou Redorta, J., & Rouprêt, M.
Affiliations: Charles University (CZ)
Universitätsklinikum Würzburg (DE)
Medical University of Graz (AT)
Vienna General Hospital (AT)
European Organisation for Research and Treatment of Cancer (NL)
Hyvinkää Hospital (FI)
Corresponding author: Babjuk, Marko
ORCID: Babjuk, Marko
Burger, Maximilian
Shariat, Shahrokh F.
Sylvester, Richard J.
Venue: European Urology
Publisher: Elsevier BV
Published: 2013-10
Volume: 64
Issue: 4
Pages: 639-653
ISSN: 0302-2838 (ISSN-L)
DOI: 10.1016/j.eururo.2013.06.003
OpenAlex: W2151781453
Cited by: 1,174
References: 116
Citations by year: 2026: 8 · 2025: 20 · 2024: 34 · 2023: 34 · 2022: 50 · 2021: 47 · 2020: 48 · 2019: 70 · 2018: 94 · 2017: 166 · 2016: 210 · 2015: 240 · 2014: 135 · 2013: 16
FWCI: 197.64
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: European Urology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Bladder and Urothelial Cancer Treatments
Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
Health Sciences › Medicine › Surgery › Urinary and Genital Oncology Studies
Keywords: non-muscle-invasive bladder cancer, carcinoma in situ, transurethral resection, intravesical chemotherapy, BCG vaccine, radical cystectomy, BCG-refractory disease, adjuvant therapy, papillary tumors, cystoscopy
MeSH terms: Administration, Intravesical, Antineoplastic Agents, BCG Vaccine, Biopsy, Urinary Bladder Neoplasms, Carcinoma, Cystoscopy, Diagnostic Techniques, Urological, Europe, Humans, Neoplasm Invasiveness, Neoplasm Staging, Predictive Value of Tests, Societies, Medical, Urology, Cystectomy, Treatment Outcome, Chemotherapy, Adjuvant, Disease Progression, Evidence-Based Medicine, Urothelium, Neoplasm Grading

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EAU Guidelines on Non–Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2013

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