Swedish national guidelines on urothelial carcinoma: 2024 update on advanced and metastatic disease.

IF 1.4 4区 医学 Q3 UROLOGY & NEPHROLOGY
Anders Ullén, Firas Aljabery, Pär Dahlman, Karin Falkman, Truls Gårdmark, Tomas Jerlström, Susanna Holst, Sofia Kjellström, Anna-Karin Lind, Dimitrios Papantoniou, Jonas Stenlund, Viveka Ströck, Karin Söderkvist, Helena Thulin, Elin Trägårdh, Ingrida Verbiene, Jonas Wallström, Elisabeth Öfverholm, Fredrik Liedberg
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引用次数: 0

Abstract

Objective: To overview and summarise the Swedish National Guidelines on Urothelial Carcinoma 2024.

Methods: A narrative review of the updated guidelines was performed, highlighting new treatment recommendations for advanced and metastasized disease.  Results: Compared to the previous guideline version, the current update includes recommendations for standardised radiological reporting when urothelial carcinomas are detected at CT-urography (CTU), to early identify locally advanced patients and accelerate the care pathway for these patients. The Swedish guidelines apply a more structured and liberal recommendation for the use of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography in patients with locally advanced urothelial carcinomas compared to the EAU-guidelines and recommend such examinations prior to transurethral resection. Improved outcomes for radical cystectomy in Sweden after centralised cystectomy care have led to a recommendation for performing more than six nephroureterectomies (NUs) per year for upper tract urothelial carcinomas (UTUC)-based associations with decreased use of invasive diagnostic modalities and better survival outcomes. Additionally, updated recommendations regarding adjuvant systemic therapies for muscle-invasive disease have been included. Whilst awaiting national regulatory approval for enfortumab vedotin/pembrolizumab, the present guideline version aligns with EAU-guidelines by endorsing cisplatin-gemcitabine-nivolumab as a new first-line treatment option in cisplatin-fit patients with unresectable or metastatic urothelial carcinoma.

Conclusions: The current version of the Swedish national guidelines on urothelial carcinoma introduces standardised reporting at CTU to facilitate early identification of advanced disease, includes recommendations for centralisation of NU for UTUC and updated recommendations for adjuvant systemic treatment of muscle-invasive disease and endorses cisplatin-gemcitabine-nivolumab as a new first-line treatment option for non-resectable locally advanced and metastatic disease.

瑞典尿路上皮癌国家指南:晚期和转移性疾病2024年更新
目的:概述和总结瑞典国家尿路上皮癌指南2024。方法:对更新的指南进行叙述性回顾,重点介绍了晚期和转移性疾病的新治疗建议。结果:与之前的指南版本相比,当前的更新包括了在ct尿路造影(CTU)检测到尿路上皮癌时标准化放射报告的建议,以早期识别局部晚期患者并加快这些患者的护理途径。与eau指南相比,瑞典指南对局部晚期尿路上皮癌患者使用18f -氟脱氧葡萄糖-正电子发射断层扫描/计算机断层扫描的建议更为结构化和宽松,并建议在经尿道切除术前进行此类检查。在瑞典,集中膀胱切除术治疗后根治性膀胱切除术的预后有所改善,因此推荐每年对基于上尿路上皮癌(UTUC)的患者进行6次以上肾输尿管切除术(NUs),同时减少侵入性诊断方式的使用,改善生存结果。此外,关于肌肉侵袭性疾病的辅助全身性治疗的最新建议也包括在内。在等待国家监管机构批准enfortumab vedotin/pembrolizumab的同时,目前的指南版本与eu指南一致,支持顺铂-吉西他滨-尼沃单抗作为顺铂适合患者不可切除或转移性尿路上皮癌的新的一线治疗选择。结论:当前版本的瑞典尿路上皮癌国家指南引入了CTU的标准化报告,以促进晚期疾病的早期识别,包括推荐UTUC的NU集中治疗和肌肉侵袭性疾病的辅助全身治疗的更新建议,并支持顺铂-吉西他滨-尼沃单抗作为不可切除的局部晚期和转移性疾病的新的一线治疗选择。
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来源期刊
Scandinavian Journal of Urology
Scandinavian Journal of Urology UROLOGY & NEPHROLOGY-
CiteScore
2.90
自引率
6.70%
发文量
70
期刊介绍: Scandinavian Journal of Urology is a journal for the clinical urologist and publishes papers within all fields in clinical urology. Experimental papers related to clinical questions are also invited.Important reports with great news value are published promptly.
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