French AFU Cancer Committee Guidelines - Update 2022-2024: Muscle-Invasive Bladder Cancer (MIBC).

To update the CCAFU recommendations for the management of muscle invasive bladder carcinoma (MIBC).

A systematic review (Medline) of the literature from 2020 to 2022 was performed taking account of the diagnosis, treatment options and surveillance of NMIBC and MIBC, while evaluating the references with their levels of evidence.

MIBC is diagnosed after the most complete tumour resection possible. MIBC grading is based on CTU along with chest CT. Multiparametric pelvic MRI could be an alternative. Cystectomy with extensive lymphadenectomy is the gold standard treatment for non-metastatic MIBC. It should be preceded by platinum-based neoadjuvant chemotherapy in patients in good general health with satisfactory renal function. Enterocystoplasty is proposed in men and women in the absence of contraindications and when the urethral resection is negative on extemporaneous examination. Otherwise, transileal cutaneous ureterostomy is the recommended method of urinary diversion. Inclusion of all patients in an ERAS (Enhanced Recovery After Surgery) protocol is recommended. For metastatic MIBC, first line treatment with platinum-based chemotherapy (GC or MVAC) is recommended, if general health (PS>1) and renal function (clearance>60mL/min) so allow (only 50% of the cases). Pembrolizumab immunotherapy has demonstrated an overall survival benefit in second-line treatment.

Updating the ccAFU recommendations should contribute to improving patient management, as well as the diagnosis and decision-making concerning MIBC treatment.

Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2022 Nov [Epub]

Y Neuzillet, F Audenet, Y Loriot, Y Allory, A Masson-Lecomte, P Leon, B Pradère, T Seisen, O Traxer, E Xylinas, M Roumiguié, M Roupret

Service d'urologie, hôpital Foch, université Paris Saclay, Suresnes, France. Electronic address: ., Service d'urologie, hôpital européen Georges-Pompidou, AP-HP Centre, université Paris Cité, Paris, France., Service d'oncologie médicale, institut Gustave Roussy, Villejuif, France., Service d'anatomopathologie, institut Curie, université Paris Saclay, Saint-Cloud, France., Service d'urologie, hôpital Saint-Louis, AP-HP, université Paris Cité, France., Service d'urologie, clinique Pasteur, Royan, France., Service d'urologie UROSUD, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France., Sorbonne université, GRC 5 Predictive Onco-Uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France., Sorbonne université, GRC#20 Lithiase Urinaire et EndoUrologie, AP-HP, urologie, hôpital Tenon, 75020 Paris, France., Service d'urologie, hôpital Bichat-Claude Bernard, AP-HP, université Paris Cité, Paris, France., Service d'urologie, CHU de Toulouse, UPS, université de Toulouse, Toulouse, France.

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