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      Treatment and surveillance for non-muscle-invasive bladder cancer: a clinical practice guideline (2021 edition)

      research-article
      1 , 1 , 2 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 1 , 2 , 9 , 10 , 11 , 12 , 1 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 1 , 1 , 7 , 21 , 22 , 1 , 23 , 24 , 25 , , 26 , , 1 , 2 , , 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)
      Military Medical Research
      BioMed Central
      Non-muscle invasive bladder cancer, Bladder cancer, Transurethral resection of bladder tumor, Treatment, Surveillance, Guideline

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          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.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s40779-022-00406-y.

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          Most cited references142

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          Bladder Cancer: A Review

          Bladder cancer is a common malignancy in women and is the fourth most common malignancy in men. Bladder cancer ranges from unaggressive and usually noninvasive tumors that recur and commit patients to long-term invasive surveillance, to aggressive and invasive tumors with high disease-specific mortality.
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            Bladder cancer.

            Bladder cancer is a complex disease associated with high morbidity and mortality rates if not treated optimally. Awareness of haematuria as the major presenting symptom is paramount, and early diagnosis with individualised treatment and follow-up is the key to a successful outcome. For non-muscle-invasive bladder cancer, the mainstay of treatment is complete resection of the tumour followed by induction and maintenance immunotherapy with intravesical BCG vaccine or intravesical chemotherapy. For muscle-invasive bladder cancer, multimodal treatment involving radical cystectomy with neoadjuvant chemotherapy offers the best chance for cure. Selected patients with muscle-invasive tumours can be offered bladder-sparing trimodality treatment consisting of transurethral resection with chemoradiation. Advanced disease is best treated with systemic cisplatin-based chemotherapy; immunotherapy is emerging as a viable salvage treatment for patients in whom first-line chemotherapy cannot control the disease. Developments in the past 2 years have shed light on genetic subtypes of bladder cancer that might differ from one another in response to various treatments.
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              Is Open Access

              Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better?

              Methodological quality (risk of bias) assessment is an important step before study initiation usage. Therefore, accurately judging study type is the first priority, and the choosing proper tool is also important. In this review, we introduced methodological quality assessment tools for randomized controlled trial (including individual and cluster), animal study, non-randomized interventional studies (including follow-up study, controlled before-and-after study, before-after/ pre-post study, uncontrolled longitudinal study, interrupted time series study), cohort study, case-control study, cross-sectional study (including analytical and descriptive), observational case series and case reports, comparative effectiveness research, diagnostic study, health economic evaluation, prediction study (including predictor finding study, prediction model impact study, prognostic prediction model study), qualitative study, outcome measurement instruments (including patient - reported outcome measure development, content validity, structural validity, internal consistency, cross-cultural validity/ measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, and responsiveness), systematic review and meta-analysis, and clinical practice guideline. The readers of our review can distinguish the types of medical studies and choose appropriate tools. In one word, comprehensively mastering relevant knowledge and implementing more practices are basic requirements for correctly assessing the methodological quality.
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                Author and article information

                Contributors
                jinyinghui0301@163.com
                zengxiantao1128@163.com
                liutongzu@163.com
                hkbzm59@aliyun.com
                d-zling@qq.com
                dingdgang@163.com
                13898475160@163.com
                hanping@scu.edu.cn
                hyrrenji2@aliyun.com
                hxsurgeon@whu.edu.cn
                Mingli23455@sina.com
                hhyylxd2013@126.com
                13808549738@qq.com
                Xuhuili2011@whu.edu.cn
                liang_chaozhao@163.com
                jiumin8388@163.com
                mahongshun@hotmail.com
                jasonqi@sh163.net
                Shijiaqigy@aliyun.com
                jianwang0330@sina.com
                dlwangws@sina.com
                zhipzhang11@163.com
                zn003578@whu.edu.cn
                wangyb20172030@whu.edu.cn
                wq933@hotmail.com
                haiboxia8360101@163.com
                xmcua2007@sina.com
                yansiyu@whu.edu.cn
                zhangxuepei@263.net
                zhengguoyou2008@126.com
                xingnianzeng@126.com
                hedl@xjtu.edu.cn
                wangxinghuan1965@163.com
                Journal
                Mil Med Res
                Mil Med Res
                Military Medical Research
                BioMed Central (London )
                2095-7467
                2054-9369
                17 August 2022
                17 August 2022
                2022
                : 9
                : 44
                Affiliations
                [1 ]GRID grid.413247.7, ISNI 0000 0004 1808 0969, Center for Evidence-Based and Translational Medicine, , Zhongnan Hospital of Wuhan University, ; Wuhan, 430071 China
                [2 ]GRID grid.413247.7, ISNI 0000 0004 1808 0969, Department of Urology, Institute of Urology, , Zhongnan Hospital of Wuhan University, ; Wuhan, 430071 China
                [3 ]Department of Urology, Haikou People’s Hospital, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou, 570208 China
                [4 ]GRID grid.453074.1, ISNI 0000 0000 9797 0900, Department of Urology, the First Affiliated Hospital and College of Clinical Medicine, , Henan University of Science and Technology, ; Luoyang, 450052 Henan China
                [5 ]GRID grid.414011.1, ISNI 0000 0004 1808 090X, Department of Urology, , Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, ; Zhengzhou, 450003 China
                [6 ]GRID grid.452828.1, ISNI 0000 0004 7649 7439, Department of Urology, , the Second Hospital of Dalian Medical University, ; Dalian, 116023 Liaoning China
                [7 ]GRID grid.412901.f, ISNI 0000 0004 1770 1022, Department of Urology, Institute of Urology, , West China Hospital, Sichuan University, ; Chengdu, 610041 China
                [8 ]GRID grid.16821.3c, ISNI 0000 0004 0368 8293, Department of Urology, Renji Hospital, School of Medicine, , Shanghai Jiao Tong University, ; Shanghai, 200120 China
                [9 ]GRID grid.410644.3, Department of Urology, , the People’s Hospital of Xinjiang Uygur Autonomous Region, ; Urumqi, 830002 China
                [10 ]GRID grid.256922.8, ISNI 0000 0000 9139 560X, Department of Urology, , Huaihe Hospital of Henan University, ; Kaifeng, 475000 Henan China
                [11 ]GRID grid.256922.8, ISNI 0000 0000 9139 560X, Institutes of Evidence-Based Medicine and Knowledge Translation, , Henan University, ; Kaifeng, 475000 Henan China
                [12 ]GRID grid.256112.3, ISNI 0000 0004 1797 9307, Department of Urology, , the Second Affiliated Hospital and Second Clinical Medical College of Fujian Medical University, ; Quanzhou, 362000 Fujian China
                [13 ]GRID grid.412679.f, ISNI 0000 0004 1771 3402, Department of Urology, , the First Affiliated Hospital of Anhui Medical University, ; Hefei, 230022 China
                [14 ]GRID grid.410643.4, Department of Urology, Guangdong Provincial People’s Hospital, , Guangdong Academy of Medical Sciences, ; Guangzhou, 510080 China
                [15 ]GRID grid.417024.4, ISNI 0000 0004 0605 6814, Department of Urology, , Tianjin First Central Hospital, ; Tianjin, 300190 China
                [16 ]GRID grid.16821.3c, ISNI 0000 0004 0368 8293, Department of Urology, Xinhua Hospital, School of Medicine, , Shanghai Jiao Tong University School of Medicine, ; Shanghai, 200092 China
                [17 ]GRID grid.452244.1, Department of Urology, , Affiliated Hospital of Guizhou Medical University, ; Guiyang, 550004 China
                [18 ]GRID grid.459333.b, Department of Urology, , Qinghai University Affiliated Hospital, ; Xining, 810012 China
                [19 ]GRID grid.452206.7, ISNI 0000 0004 1758 417X, Department of Urology, , the First Affiliated Hospital of Chongqing Medical University, ; Chongqing, 400042 China
                [20 ]GRID grid.411294.b, ISNI 0000 0004 1798 9345, Department of Urology, Institute of Urology, , Lanzhou University Second Hospital, Key Laboratory of Urological Diseases in Gansu Province, ; Lanzhou, 730030 China
                [21 ]GRID grid.443353.6, ISNI 0000 0004 1798 8916, Department of Urology, , Chifeng Cancer Hospital, the Second Affiliated Hospital of Chifeng University, ; Chifeng, 024000 Inner Mongolia Autonomous Region China
                [22 ]GRID grid.412625.6, Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology, , the First Affiliated Hospital of Xiamen University, ; Xiamen, 361003 China
                [23 ]GRID grid.412633.1, ISNI 0000 0004 1799 0733, Department of Urology, , the First Affiliated Hospital of Zhengzhou University, ; Zhengzhou, 450052 China
                [24 ]GRID grid.430605.4, ISNI 0000 0004 1758 4110, Department of Urology, , the Second Division of the First Hospital of Jilin University, ; Changchun, 130061 China
                [25 ]GRID grid.506261.6, ISNI 0000 0001 0706 7839, 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
                [26 ]GRID grid.452438.c, ISNI 0000 0004 1760 8119, Department of Urology, , the First Affiliated Hospital of Xi’an Jiaotong University, ; Xi’an 710061, China
                Author information
                http://orcid.org/0000-0002-2877-4345
                Article
                406
                10.1186/s40779-022-00406-y
                9382792
                35978389
                854b9ee8-5b65-45ae-b064-552283012fe2
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 11 April 2022
                : 2 August 2022
                Funding
                Funded by: National Key Research and Development Plan of China
                Award ID: Technology helps Economy 2020
                Award Recipient :
                Categories
                Position article and Guideline
                Custom metadata
                © The Author(s) 2022

                non-muscle invasive bladder cancer,bladder cancer,transurethral resection of bladder tumor,treatment,surveillance,guideline

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