c21bad59ddcf9b00a615be3945bad07e 320777.pdf e68edbdb4c8fe61ba081bfb3ce38aca2378edeeb 320777.pdf 829eee2a74544255515c555a488826fbe960fbd039d9f93c9286a0cd5d731319 320777.pdf Title: Active Surveillance in Non-Muscle Invasive Bladder Cancer: A Systematic Review Subject: Bladder cancer is the ninth most common cancer globally, with most cases classified as non-muscle-invasive bladder cancer (NMIBC). While transurethral resection of the bladder tumor (TURBT) remains the gold-standard treatment, its complications, high recurrence rates, and economic burden have prompted interest in alternative strategies like active surveillance (AS) for low-grade and low-grade NMBIC recurrences. AS minimizes surgical interventions and patient burden, but lacks standardized protocols for inclusion criteria and follow-up schedules. Most studies suggest intensive monitoring during the first year, with criteria often based on tumor size, number, and grade. Acquisition of evidence: A comprehensive literature search was conducted in December 2024 using Pubmed, Cochrane, and Trip databases to identify studies on AS for low-grade NMBIC recurrences. Only English studies were included, with Boolean operators used to refine the search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Population, Intervention, Comparison and Outcomes (PICO) selection criteria were followed. The Newcastle–Ottawa quality assessment scale was used to analyze the quality of the included studies. Evidence synthesis: This systematic review included 11 studies evaluating AS for NMIBC. Early studies, such demonstrated AS as a feasible alternative to TURBT, with low progression rates. Subsequent research confirmed its safety in selected patients, with tumor growth and positive cytology being the main reasons for intervention. More recent investigations, further supported AS as a viable strategy, highlighting the low risk of stage and grade progression and its potential to reduce surgical interventions. Conclusions: AS may be considered an alternative approach for low-risk NMIBC recurrences. However, there is need for prospective studies and personalized approaches to optimize AS, addressing follow-up strategies, inclusion criteria and progression thresholds. Keywords: non-muscle invasive bladder cancer; active surveillance; expectant management; TURBT; cystoscopy Author: Míriam Campistol, Fernando Lozano, Albert Carrion, Carles Xavier Raventós, Juan Morote and Enrique Trilla Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Tue May 20 13:57:26 2025 CEST ModDate: Tue May 20 13:59:18 2025 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 614905 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- DDIDBU+URWPalladioL-Roma Type 1 Custom yes yes yes 10 0 WTUSKL+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 RPLXDA+URWPalladioL-Ital Type 1 Custom yes yes yes 21 0 WOWCNF+CMSY10 Type 1 Builtin yes yes yes 47 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 61 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 65 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 69 0 URYLRZ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 80 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-10-22 03:52:19 CEST RepresentationInformation: 320777.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-10-21 12:23:09 CEST Size: 614905 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 311 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Acquisition of Evidence Destination: section.2 Children: Item: Title: Search Strategy and Results Destination: subsection.2.1 Item: Title: Quality Assessment Destination: subsection.2.2 Item: Title: Data Extraction Destination: subsection.2.3 Item: Title: Evidence Synthesis Destination: section.3 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Active Surveillance in Non-Muscle Invasive Bladder Cancer: A Systematic Review Author: Míriam Campistol, Fernando Lozano, Albert Carrion, Carles Xavier Raventós, Juan Morote and Enrique Trilla Subject: Bladder cancer is the ninth most common cancer globally, with most cases classified as non-muscle-invasive bladder cancer (NMIBC). While transurethral resection of the bladder tumor (TURBT) remains the gold-standard treatment, its complications, high recurrence rates, and economic burden have prompted interest in alternative strategies like active surveillance (AS) for low-grade and low-grade NMBIC recurrences. AS minimizes surgical interventions and patient burden, but lacks standardized protocols for inclusion criteria and follow-up schedules. Most studies suggest intensive monitoring during the first year, with criteria often based on tumor size, number, and grade. Acquisition of evidence: A comprehensive literature search was conducted in December 2024 using Pubmed, Cochrane, and Trip databases to identify studies on AS for low-grade NMBIC recurrences. Only English studies were included, with Boolean operators used to refine the search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Population, Intervention, Comparison and Outcomes (PICO) selection criteria were followed. The Newcastle Ottawa quality assessment scale was used to analyze the quality of the included studies. Evidence synthesis: This systematic review included 11 studies evaluating AS for NMIBC. Early studies, such demonstrated AS as a feasible alternative to TURBT, with low progression rates. Subsequent research confirmed its safety in selected patients, with tumor growth and positive cytology being the main reasons for intervention. More recent investigations, further supported AS as a viable strategy, highlighting the low risk of stage and grade progression and its potential to reduce surgical interventions. Conclusions: AS may be considered an alternative approach for low-risk NMIBC recurrences. However, there is need for prospective studies and personalized approaches to optimize AS, addressing follow-up strategies, inclusion criteria and progression thresholds. 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