Risk Stratification

風(fēng)險(xiǎn)分層

5. At the time of each occurrence/recurrence, a clinician should assign a clinical stage and classify a patient accordingly as “l(fā)ow-,” “intermediate-,” or “high-risk.” (Moderate Recommendation; Evidence Strength: Grade C)

5. 在每次腫瘤發(fā)生/復(fù)發(fā)時(shí),，醫(yī)生應(yīng)評(píng)估臨床分期，并相應(yīng)地將患者分為“低?！?、“中危”或“高?！苯M,。（中度推薦；證據(jù)強(qiáng)度：C級(jí)）

Variant Histologies

組織學(xué)變異

6. An experienced genitourinary pathologist should review the pathology of a patient with any doubt in regards to variant or suspected variant histology (e.g., micropapillary, nested, plasmacytoid, neuroendocrine, sarcomatoid), extensive squamous or glandular differentiation, or the presence/absence of LVI. (Moderate Recommendation; Evidence Strength: Grade C)

6. 經(jīng)驗(yàn)豐富的泌尿生殖病理學(xué)家應(yīng)回顧分析每例患者的病理組織學(xué)變異或疑似變異（如微乳頭狀,、巢狀,、漿細(xì)胞樣、神經(jīng)內(nèi)分泌,、肉瘤樣變）,、廣泛的鱗狀或腺樣分化、是否存在淋巴血管侵犯,。（中度推薦,；證據(jù)強(qiáng)度：C級(jí)）

7. If a bladder sparing approach is being considered in a patient with variant histology, then a clinician should perform a restaging TURBT within four to six weeks of the initial TURBT. (Expert Opinion)

7. 如果考慮保留一個(gè)存在組織學(xué)變異患者的膀胱，那么臨床醫(yī)生應(yīng)在初次TURBT后4到6周內(nèi)重新進(jìn)行TURBT再次分級(jí),。（專(zhuān)家意見(jiàn)）

8. Due to the high rate of upstaging associated with variant histology, a clinician should consider offering initial radical cystectomy. (Expert Opinion)

8.由于組織學(xué)變異時(shí)臨床分期上調(diào)的概率很高,，臨床醫(yī)生就應(yīng)考慮初期根治性膀胱切除術(shù)。（專(zhuān)家意見(jiàn)）

TURBT/Repeat resection: Timing,，Technique，Goal,，Indication

經(jīng)尿道膀胱腫瘤電切術(shù)/重復(fù)切除：時(shí)機(jī),、技術(shù)、目標(biāo),、適應(yīng)癥

12. In a patient with non-muscle invasive disease who underwent an incomplete initial resection (not all visible tumor treated), a clinician should perform repeat transurethral resection or endoscopic treatment of all remaining tumor if technically feasible. (Strong Recommendation; Evidence Strength: Grade B)

12. 對(duì)于非肌層浸潤(rùn)性膀胱癌且初次切除不徹底（不是所有肉眼可見(jiàn)的腫瘤都被切除干凈）的患者,，如果技術(shù)可行，臨床醫(yī)生應(yīng)考慮對(duì)所有殘余的腫瘤再次進(jìn)行經(jīng)尿道切除或內(nèi)窺鏡治療,。（強(qiáng)烈推薦,；證據(jù)強(qiáng)度：B級(jí)）

13. In a patient with high-risk, high-grade Ta tumors, a clinician should consider performing repeat transurethral resection of the primary tumor site within six weeks of the initial TURBT. (Moderate Recommendation; Evidence Strength: Grade C)

13. 對(duì)于高危、高級(jí)別Ta期腫瘤,，臨床醫(yī)生應(yīng)考慮在初次TURBT后6周內(nèi)對(duì)原發(fā)腫瘤部位再次進(jìn)行經(jīng)尿道切除術(shù),。（中度推薦；證據(jù)強(qiáng)度：C級(jí)）

14. In a patient with T1 disease, a clinician should perform repeat transurethral resection of the primary tumor site to include muscularis propria within six weeks of the initial TURBT. (Strong Recommendation; Evidence Strength: Grade B)

14. 對(duì)于T1期腫瘤的患者,，臨床醫(yī)生應(yīng)在初次TURBT后6周內(nèi)對(duì)原發(fā)腫瘤部位再次進(jìn)行包括固有肌層在內(nèi)的經(jīng)尿道切除,。（強(qiáng)烈推薦；證據(jù)強(qiáng)度：B級(jí)）

Intravesical Therapy; BCG/Maintenance; Chemotherapy/ BCG Combinations

膀胱灌注療法,；卡介苗/維持療法,；化療/卡介苗聯(lián)合療法

15. In a patient with suspected or known low- or intermediate-risk bladder cancer, a clinician should consider administration of a single postoperative instillation of intravesical chemotherapy (e.g., mitomycin C or epirubicin) within 24 hours of TURBT. In a patient with a suspected perforation or extensive resection, a clinician should not use postoperative chemotherapy. (Moderate Recommendation; Evidence Strength: Grade B)

15. 對(duì)于懷疑或已知為低危或中危膀胱癌的患者,，臨床醫(yī)生應(yīng)考慮在TURBT后24小時(shí)內(nèi)單次膀胱內(nèi)灌注化療（如絲裂霉素C或表阿霉素）,。對(duì)于懷疑有膀胱穿孔或切除范圍廣泛的患者，臨床醫(yī)生不應(yīng)使用術(shù)后即刻膀胱內(nèi)灌注化療,。（中度推薦,；證據(jù)強(qiáng)度：B級(jí)）

16. In a low-risk patient, a clinician should not administer induction intravesical therapy. (Moderate Recommendation; Evidence Strength: Grade C)

16. 對(duì)于低危患者,，臨床醫(yī)生不應(yīng)進(jìn)行誘導(dǎo)性膀胱腔內(nèi)治療,。（中度推薦；證據(jù)強(qiáng)度：C級(jí)）

17. In an intermediate-risk patient a clinician should consider administration of a six week course of induction intravesical chemotherapy or immunotherapy. (Moderate Recommendation; Evidence Strength: Grade B)

17. 對(duì)于中?；颊?，臨床醫(yī)生應(yīng)考慮給予為期6周的誘導(dǎo)性膀胱腔內(nèi)化療或免疫治療。（中度推薦,；證據(jù)強(qiáng)度：B級(jí)）

18. In a high-risk patient with newly diagnosed CIS, high-grade T1, or high-risk Ta urothelial carcinoma, a clinician should administer a six-week induction course of BCG. (Strong Recommendation; Evidence Strength: Grade B)

18. 對(duì)于高危的尿路上皮癌患者（新確診且合并原位癌,、高級(jí)別T1期或高危Ta期），臨床醫(yī)生應(yīng)給予為期6周的BCG誘導(dǎo)治療,。（強(qiáng)烈推薦；證據(jù)強(qiáng)度：B級(jí)）

19. In an intermediate-risk patient who completely responds to an induction course of intravesical chemotherapy, a clinician may utilize maintenance therapy. (Conditional Recommendation; Evidence Strength: Grade C)

19. 對(duì)于膀胱腔內(nèi)誘導(dǎo)治療反應(yīng)完全的中危膀胱癌患者，臨床醫(yī)生可采用維持治療,。（有條件推薦,；證據(jù)強(qiáng)度：C級(jí)）

20. In an intermediate-risk patient who completely responds to induction BCG, a clinician should consider maintenance BCG for one year, as tolerated. (Moderate Recommendation; Evidence Strength: Grade C)

20. 對(duì)于卡介苗誘導(dǎo)治療反應(yīng)完全的中危膀胱癌患者，能耐受的情況下臨床醫(yī)生應(yīng)考慮卡介苗維持治療1年,。（中度推薦,；證據(jù)強(qiáng)度：C級(jí)）

21. In a high-risk patient who completely responds to induction BCG, a clinician should continue maintenance BCG for three years, as tolerated. (Moderate Recommendation; Evidence Strength: Grade B)

21. 對(duì)于卡介苗誘導(dǎo)治療反應(yīng)完全的高危膀胱癌患者，能耐受的情況下臨床醫(yī)生應(yīng)考慮卡介苗維持治療3年,。（中度推薦,；證據(jù)強(qiáng)度：B級(jí)）

BCG Relapse and Salvage Regimens

卡介苗復(fù)發(fā)與挽救方案

22. In an intermediate- or high-risk patient with persistent or recurrent disease or positive cytology following intravesical therapy, a clinician should consider performing prostatic urethral biopsy and an upper tract evaluation prior to administration of additional intravesical therapy. (Conditional Recommendation; Evidence Strength: Grade C)

22. 對(duì)于膀胱腔內(nèi)治療后腫瘤持續(xù)或復(fù)發(fā)，或細(xì)胞學(xué)檢查陽(yáng)性的中高危膀胱癌患者,，臨床醫(yī)生在實(shí)施進(jìn)一步膀胱腔內(nèi)治療前應(yīng)考慮進(jìn)行前列腺尿道活檢和上尿路評(píng)估,。（有條件推薦；證據(jù)強(qiáng)度：C級(jí)）

23. In an intermediate- or high-risk patient with persistent or recurrent Ta or CIS disease after a single course of induction intravesical BCG, a clinician should offer a second course of BCG. (Moderate Recommendation; Evidence Strength: Grade C)

23. 對(duì)于一個(gè)療程的膀胱腔內(nèi)卡介苗誘導(dǎo)治療后,，腫瘤持續(xù)或復(fù)發(fā)的Ta期的中,、高危患者或合并原位癌的膀胱癌患者,，臨床醫(yī)生應(yīng)提供第二個(gè)療程的卡介苗治療,。（中度推薦；證據(jù)強(qiáng)度：C級(jí)）

24. In a patient fit for surgery with high-grade T1 disease after a single course of induction intravesical BCG, a clinician should offer radical cystectomy. (Moderate Recommendation; Evidence Strength: Grade C)

24. 對(duì)于一個(gè)療程的膀胱腔內(nèi)卡介苗誘導(dǎo)治療后,，條件適宜手術(shù)的高級(jí)別T1期膀胱癌患者,，臨床醫(yī)生應(yīng)實(shí)施根治性膀胱切除術(shù)。（中度推薦,；證據(jù)強(qiáng)度：C級(jí)）

25. A clinician should not prescribe additional BCG to a patient who is intolerant of BCG or has documented recurrence on TURBT of high-grade, non-muscle-invasive disease and/or CIS within six months of two induction courses of BCG or induction BCG plus maintenance. (Moderate Recommendation; Evidence Strength: Grade C)

25. 對(duì)于不能耐受卡介苗治療的患者,，以及在兩個(gè)療程卡介苗的誘導(dǎo)治療或者卡介苗誘導(dǎo)加維持治療后6個(gè)月內(nèi)通過(guò)TURBT證實(shí)有高級(jí)別、非肌層浸潤(rùn)性膀胱癌復(fù)發(fā)和/或CIS的患者,，臨床醫(yī)生不應(yīng)再進(jìn)行卡介苗治療,。（中度推薦；證據(jù)強(qiáng)度：C級(jí)）

26. In a patient with persistent or recurrent intermediate- or high-risk NMIBC who is unwilling or unfit for cystectomy following two courses of BCG, a clinician may recommend clinical trial enrollment. A clinician may offer this patient intravesical chemotherapy when clinical trials are unavailable. (Expert Opinion)

26. 對(duì)于經(jīng)過(guò)兩個(gè)療程的卡介苗治療后持續(xù)或復(fù)發(fā)的中,、高危非肌層浸潤(rùn)性膀胱癌患者,，不愿意或不適宜進(jìn)行膀胱切除術(shù)的，臨床醫(yī)生可建議進(jìn)行臨床試驗(yàn)性治療,。當(dāng)無(wú)法實(shí)施臨床試驗(yàn)性治療時(shí),，臨床醫(yī)生可以給患者提供膀胱腔內(nèi)化療。（專(zhuān)家意見(jiàn)）

Role of Cystectomy in NMIBC

膀胱切除術(shù)在非肌層浸潤(rùn)性膀胱癌治療中的作用

27. In a patient with Ta low- or intermediate-risk disease, a clinician should not perform radical cystectomy until bladder-sparing modalities (staged TURBT, intravesical therapies) have failed. (Clinical Principle)

27. 對(duì)于Ta期低?；蛑形ｏL(fēng)險(xiǎn)的患者,，臨床醫(yī)生不應(yīng)進(jìn)行根治性膀胱切除術(shù)，直到保留膀胱的治療方法（分期TURBT,、膀胱腔內(nèi)治療）失敗,。（臨床原則）

28. In a high-risk patient who is fit for surgery with persistent high-grade T1 disease on repeat resection, or T1 tumors with associated CIS, LVI, or variant histologies, a clinician should consider offering initial radical cystectomy. (Moderate Recommendation; Evidence Strength: Grade C)

28. 對(duì)于適合手術(shù)治療的高危膀胱癌患者,，如果重復(fù)切除均提示存在高級(jí)別T1期腫瘤、T1期腫瘤合并原位癌,、存在淋巴血管侵犯或組織學(xué)變異,，臨床醫(yī)生應(yīng)初步考慮實(shí)施根治性膀胱切除術(shù)。（中度推薦,；證據(jù)強(qiáng)度：C級(jí)）

29. In a high-risk patient with persistent or recurrent disease within one year following treatment with two induction cycles of BCG or BCG maintenance, a clinician should offer radical cystectomy. (Moderate Recommendation; Evidence Strength: Grade C)

29. 在接受兩個(gè)周期的卡介苗誘導(dǎo)或維持治療后一年內(nèi)有持續(xù)或復(fù)發(fā)的高危膀胱癌患者,，臨床醫(yī)生應(yīng)實(shí)施根治性膀胱切除術(shù)。（中度推薦,；證據(jù)強(qiáng)度：C級(jí)）

Enhanced Cystoscopy

增強(qiáng)膀胱鏡檢查

30. In a patient with NMIBC, a clinician should offer blue light cystoscopy at the time of TURBT, if available, to increase detection and decrease recurrence. (Moderate Recommendation; Evidence Strength: Grade B)

30. 對(duì)于非肌層浸潤(rùn)性膀胱癌患者,，臨床醫(yī)生應(yīng)在TURBT時(shí)提供藍(lán)光膀胱鏡檢查（如果具備條件），以提高檢測(cè)率并減少?gòu)?fù)發(fā),。（中度推薦,；證據(jù)強(qiáng)度：B級(jí)）

31. In a patient with NMIBC, a clinician may consider use of NBI to increase detection and decrease recurrence. (Conditional Recommendation; Evidence Strength: Grade C)

31. 對(duì)于非肌層浸潤(rùn)性膀胱癌患者，臨床醫(yī)生可以考慮使用NBI來(lái)增加檢測(cè)和減少?gòu)?fù)發(fā),。（有條件推薦,；證據(jù)強(qiáng)度：C級(jí)）

Risk Adjusted Surveillance and Follow-up Strategies

風(fēng)險(xiǎn)調(diào)整監(jiān)測(cè)和隨訪(fǎng)策略

32. After completion of the initial evaluation and treatment of a patient with NMIBC, a clinician should perform the first surveillance cystoscopy within three to four months. (Expert Opinion)

32. 在完成對(duì)非肌層浸潤(rùn)性膀胱癌患者的初步評(píng)估和治療后，臨床醫(yī)生應(yīng)在3至4個(gè)月內(nèi)進(jìn)行第一次膀胱鏡檢查,。（專(zhuān)家意見(jiàn)）

33. For a low-risk patient whose first surveillance cystoscopy is negative for tumor, a clinician should perform subsequent surveillance cystoscopy six to nine months later, and then annually thereafter; surveillance after five years in the absence of recurrence should be based on shared-decision making between the patient and clinician. (Moderate Recommendation; Evidence Strength: Grade C)

33. 對(duì)于首次隨訪(fǎng)膀胱鏡監(jiān)測(cè)腫瘤陰性的低?；颊撸R床醫(yī)生應(yīng)在6至9個(gè)月后進(jìn)行后續(xù)的膀胱鏡監(jiān)測(cè),，此后每年進(jìn)行一次,；在無(wú)復(fù)發(fā)的情況下，五年后的監(jiān)測(cè)頻率應(yīng)基于患者和臨床醫(yī)生的共同決策,。（中度推薦,；證據(jù)強(qiáng)度：C級(jí)）

34. In an asymptomatic patient with a history of low-risk NMIBC, a clinician should not perform routine surveillance upper tract imaging. (Expert Opinion)

34. 對(duì)于有低危非肌層浸潤(rùn)性膀胱癌病史的無(wú)癥狀患者，臨床醫(yī)生不應(yīng)進(jìn)行常規(guī)上尿路成像監(jiān)測(cè),。（專(zhuān)家意見(jiàn)）

35. In a patient with a history of low-grade Ta disease and a noted sub-centimeter papillary tumor(s), a clinician may consider in-office fulguration as an alternative to resection under anesthesia. (Expert Opinion)

35. 對(duì)于有低級(jí)別Ta期腫瘤病史且有亞厘米級(jí)乳頭狀腫瘤的患者,，臨床醫(yī)生可考慮將門(mén)診電灼作為麻醉下切除的替代方法。（專(zhuān)家意見(jiàn)）

36. For an intermediate-risk patient whose first surveillance cystoscopy is negative for tumor, a clinician should perform subsequent cystoscopy with cytology every 3-6 months for 2 years, then 6-12 months for years 3 and 4, and then annually thereafter. (Expert Opinion)

36．對(duì)于首次膀胱鏡監(jiān)測(cè)為陰性的中危膀胱癌患者,，臨床醫(yī)生應(yīng)在隨后2年內(nèi)每3-6個(gè)月進(jìn)行一次膀胱鏡檢查,，然后在3-4年內(nèi)每6-12個(gè)月進(jìn)行一次，之后每年進(jìn)行一次,。（專(zhuān)家意見(jiàn)）

37. For a high-risk patient whose first surveillance cystoscopy is negative for tumor, a clinician should perform subsequent cystoscopy with cytology every three to four months for two years, then six months for years three and four, and then annually thereafter. (Expert Opinion)

37. 對(duì)于首次膀胱鏡監(jiān)測(cè)為陰性的高危膀胱癌患者,，臨床醫(yī)生應(yīng)在隨后兩年內(nèi)每3-4個(gè)月進(jìn)行一次膀胱鏡檢查，然后在3-4年內(nèi)每6個(gè)月進(jìn)行一次,，之后每年進(jìn)行一次,。（專(zhuān)家意見(jiàn)）

38. For an intermediate- or high-risk patient, a clinician should consider performing surveillance upper tract imaging at one to two year intervals. (Expert Opinion)

38. 對(duì)于中危或高危膀胱癌患者,，臨床醫(yī)生應(yīng)考慮每隔一到兩年進(jìn)行一次上尿路成像監(jiān)測(cè),。（專(zhuān)家意見(jiàn)）

*翻譯僅供學(xué)習(xí)交流,，不作為臨床實(shí)踐標(biāo)準(zhǔn)