title: Indication for early cystectomy in nonmuscle-invasive bladder cancer. Literature review.
abstract: BACKGROUND
  High-risk nonmuscle-invasive bladder cancer is a disease that includes a heterogeneous group of patients, for whom close follow-up is recommended due to the risk of progression to a muscle-invasive tumour. The treatment of choice for these tumours is transurethral resection of the bladder tumour followed by a programme of bacillus Calmette-Guerin instillations. There is a subgroup of patients who have a greater risk of progression and who benefit from early radical treatment.
  
  
  OBJECTIVE
  To identify which patient group with nonmuscle-invasive bladder cancer will benefit from early radical treatment.
  We performed a literature review to identify the risk factors for progression for these patients and thereby recommend a treatment that improves their survival rate.
  We identified the various prognostic factors associated with tumour progression: the persistence of T1 tumour in re-resection of the bladder tumour, the presence of carcinoma in situ, patients refractory to bacillus Calmette-Guerin treatment, patients older than 70 years, tumours larger than 3cm, the substaging of T1 tumours, the presence of lymphovascular invasion and the presence of a tumour in the prostatic urethra. Similarly, we comment on the advantages of radical versus conservative treatment, considering that the performance of an early cystectomy due to a high-risk noninvasive vesical tumour has a better cancer prognosis than those in which the operation is deferred until the progression.
  
  
  CONCLUSIONS
  In this disease, it is important to individualise the patients to provide them personalized treatment. For patients with the previously mentioned characteristics, it is recommended that early cystectomy not be delayed.
authors.affiliation: Servicio de Urología, Hospital Universitario Infanta Sofía, Madrid, España. Electronic address: leopoldocogorno@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Cogorno Wasylkowski
authors.affiliation: Servicio de Urología, Hospital Universitario Infanta Sofía, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Ríos-González
authors.affiliation: Servicio de Urología, Hospital Universitario Infanta Sofía, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Linares Espinós
authors.affiliation: Servicio de Urología, Hospital Universitario Infanta Sofía, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Leibar Tamayo
authors.affiliation: Servicio de Urología, Hospital Universitario Infanta Sofía, Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: Martínez-Piñeiro Lorenzo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000627:therapeutic use; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000601:surgery; D015653:Cystectomy; D018450:Disease Progression; D019317:Evidence-Based Medicine; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D057285:Precision Medicine; D013997:Time Factors; D014521:Urethra / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy
chemical_list: D001500:BCG Vaccine
keywords: Alto riesgo; Bacillus Calmette-Guerin; Bacilo de Calmette-Guerin; Cistectomía; Cystectomy; Cáncer vesical no músculo infiltrante; High risk; Nonmuscle-invasive bladder cancer