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Clinical Practice Recommendations for the Management of Non–Muscle Invasive Bladder Cancer  Donald Lamm, Marc Colombel, Raj Persad, Mark Soloway, Andreas.

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Presentation on theme: "Clinical Practice Recommendations for the Management of Non–Muscle Invasive Bladder Cancer  Donald Lamm, Marc Colombel, Raj Persad, Mark Soloway, Andreas."— Presentation transcript:

1 Clinical Practice Recommendations for the Management of Non–Muscle Invasive Bladder Cancer 
Donald Lamm, Marc Colombel, Raj Persad, Mark Soloway, Andreas Böhle, Joan Palou, J. Alfred Witjes, Hideyuki Akaza, Roger Buckley, Maurizio Brausi  European Urology Supplements  Volume 7, Issue 10, Pages (October 2008) DOI: /j.eursup Copyright © 2008 European Association of Urology Terms and Conditions

2 Fig. 1 Algorithm for the treatment and management of primary non–muscle invasive bladder cancer proposed by the International Bladder Cancer Group. Caveat: For ease of use, these recommendations have been simplified and, therefore, will need to be customised for each individual patient. For example, a high-risk patient with a low-grade Ta recurrence on maintenance BCG would be a candidate for intravesical chemotherapy rather than cystectomy as shown in the algorithm. TURBT=transurethral resection of the bladder tumour; BCG=bacillus Calmette-Guérin; CIS=carcinoma in situ. * Except in those with obvious or suspected bladder wall perforation. † Efficacy of single, immediate chemotherapeutic instillation not studied in high-risk disease. European Urology Supplements 2008 7, DOI: ( /j.eursup ) Copyright © 2008 European Association of Urology Terms and Conditions

3 Fig. 2 (a) Tumour recurrence (all studies) with odds ratio as effect size. (b) Tumour recurrence (all studies by maintenance) with odds ratio as effect size. (c) Forest plot of tumour recurrence (all studies by maintenance and risk group) with odds ratio as effect size. Mainten=BCG maintenance regimen; OR=odds ratio; interm=intermediate; Lower, Upper=lower and upper 95% CI of OR; BCG:=bacillus Calmette-Guérin; P=p value (2-sided); NTotal=total sample size; n/N=number of events per number of cases in treatment group; Fixed=fixed effect model; Random=random effect model; MMC=mitomycin C. Lines indicate 95% CI and squares OR estimates, whereas square size is proportional to sample size, and rhombs meta-analytically pooled OR estimates ±95% CI. Reprinted with permission from the American Urological Association [44]. European Urology Supplements 2008 7, DOI: ( /j.eursup ) Copyright © 2008 European Association of Urology Terms and Conditions

4 Fig. 3 (a) Forest plot of tumour progression by treatment method. (b) Forest plot of tumour progression by disease type. BCG=bacillus Calmette-Guérin; TUR=transurethral resection; CIS=carcinoma in situ; OR=odds ratio; CI=confidence interval; SD=standard deviation; maint=maintenance BCG therapy; MMC=mitomycin C; O-E=observed number of progressions minus expected number of progressions; Var=variance. Reprinted with permission from the American Urological Association [39]. European Urology Supplements 2008 7, DOI: ( /j.eursup ) Copyright © 2008 European Association of Urology Terms and Conditions


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