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.
膀胱癌是全球第九大常见癌症，其中多数病例属于非肌层浸润性膀胱癌（NMIBC）。经尿道膀胱肿瘤切除术（TURBT）虽是当前标准治疗方案，但其并发症、高复发率及经济负担促使学界探索替代策略，例如对低级别NMIBC复发患者采取主动监测（AS）。主动监测可最大限度减少手术干预并减轻患者负担，但目前缺乏关于纳入标准和随访方案的标准化规范。多数研究建议在第一年进行密集监测，其标准通常基于肿瘤大小、数量和分级。 **证据获取**：本研究于2024年12月通过Pubmed、Cochrane和Trip数据库进行系统性文献检索，筛选针对低级别NMIBC复发主动监测的相关研究。仅纳入英文文献，采用布尔运算符优化检索策略，并遵循系统综述与荟萃分析优先报告条目（PRISMA）指南及人群、干预、对照和结局（PICO）选择标准。使用纽卡斯尔-渥太华质量评估量表对纳入研究进行质量分析。 **证据综合**：本系统综述共纳入11项评估NMIBC主动监测的研究。早期研究证实主动监测可作为TURBT的可行替代方案，且疾病进展率较低。后续研究进一步验证了其在特定患者群体中的安全性，其中肿瘤生长和细胞学阳性是启动干预的主要原因。最新研究进一步支持主动监测作为可行策略，强调其分期与分级进展风险较低，并具有减少手术干预的潜力。 **结论**：对于低风险NMIBC复发患者，主动监测可被视为一种替代治疗方案。然而，仍需开展前瞻性研究并制定个体化方案以优化主动监测策略，重点关注随访方案、纳入标准和疾病进展阈值的确立。
Active Surveillance in Non-Muscle Invasive Bladder Cancer: A Systematic Review
肿瘤(癌症)患者之家