Context: High-risk nonmuscle-invasive bladder cancer is a disease that includes a heterogeneous group of patients, for whom close follow-up is recommended due to the risk of progression to a muscle-invasive tumour. The treatment of choice for these tumours is transurethral resection of the bladder tumour followed by a programme of bacillus Calmette-Guerin instillations. There is a subgroup of patients who have a greater risk of progression and who benefit from early radical treatment.
Objective: To identify which patient group with nonmuscle-invasive bladder cancer will benefit from early radical treatment.
Searching the evidence: We performed a literature review to identify the risk factors for progression for these patients and thereby recommend a treatment that improves their survival rate.
Synthesis of the evidence: We identified the various prognostic factors associated with tumour progression: the persistence of T1 tumour in re-resection of the bladder tumour, the presence of carcinoma in situ, patients refractory to bacillus Calmette-Guerin treatment, patients older than 70 years, tumours larger than 3cm, the substaging of T1 tumours, the presence of lymphovascular invasion and the presence of a tumour in the prostatic urethra. Similarly, we comment on the advantages of radical versus conservative treatment, considering that the performance of an early cystectomy due to a high-risk noninvasive vesical tumour has a better cancer prognosis than those in which the operation is deferred until the progression.
Conclusions: In this disease, it is important to individualise the patients to provide them personalized treatment. For patients with the previously mentioned characteristics, it is recommended that early cystectomy not be delayed.
Keywords: Alto riesgo; Bacillus Calmette-Guerin; Bacilo de Calmette-Guerin; Cistectomía; Cystectomy; Cáncer vesical no músculo infiltrante; High risk; Nonmuscle-invasive bladder cancer.
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