Active Surveillance in Non-Muscle Invasive Bladder Cancer: A Systematic Review
Simple Summary
Abstract
1. Introduction
2. Acquisition of Evidence
2.1. Search Strategy and Results
2.2. Quality Assessment
2.3. Data Extraction
3. Evidence Synthesis
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
NMIBC | Non-muscle-invasive bladder cancer |
AS | Active surveillance |
CIS | Carcinoma in situ |
MIBC | Muscle-invasive bladder cancer |
References
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Selection | Comparability | Outcome | ||||||
---|---|---|---|---|---|---|---|---|
Study | Representativeness of exposed cohort | Selection of non-exposed cohort | Ascertai-nment of exposure | Demonstration that outcome of interest was not present at start | Design or analysis | Ascertainment of outcome | Adequacy of follow-up | Adequacy of follow-up of cohorts |
Soloway, 2003 [23] | (+) | (+) | (+) | (+) | (+) | (+) | (+) | (-) |
Pruthi, 2008 [33] | (+) | (-) | (+) | (+) | (-) | (+) | (+) | (-) |
Gofrit, 2008 [34] | (+) | (-) | (+) | (+) | (-) | (+) | (+) | (+) |
Hernández, 2009 [35] | (+) | (+) | (+) | (+) | (+) | (+) | (+) | (+) |
Hernández, 2016 [36] | (+) | (-) | (+) | (+) | (-) | (+) | (+) | (-) |
Hurle, 2016 [37] | (+) | (-) | (+) | (+) | (-) | (+) | (+) | (-) |
Hurle, 2017 [38] | (+) | (-) | (+) | (+) | (-) | (+) | (+) | (-) |
Hurle, 2018 [39] | (+) | (-) | (+) | (+) | (-) | (+) | (+) | (-) |
Contieri, 2022 [25] | (+) | (-) | (+) | (+) | (+) | (+) | (+) | (+) |
Lokeshwar, 2022 [40] | (+) | (-) | (+) | (+) | (+) | (+) | (+) | (+) |
Tan, 2023 [41] | (+) | (-) | (+) | (+) | (+) | (+) | (+) | (+) |
Author, Year | Patients/ AS Periods | Type of Study | Inclusion Criteria | Pathological Finding Before AS | Previous Intravesical Therapy (%) | Median Follow-Up (Months) | Median AS (Months) | AS Failure Rate (%) | Grade Progression n (%) | Stage Progression n (%) | Progression to MIBC (%) | Follow-Up | Discontinuation AS | Exclusion Criteria |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Soloway MS, 2003 [23] | 32/56 | Retrospective | Small (no size reported), <4 lesions | Ta/G1/G2/G3/T1/CIS | 53 | 38 | 10.1 | 100 | 9.4 | 6.3 | 0 | Cystoscopy every 3–5 months | ||
Pruthi R, 2008 [33] | 22/32 | Retrospective | LG or HG papillary urothelial carcinoma or CIS | Ta/T1/CIS/G1/G2/G3 | 68.8 | 25 | 31.8 | 4.5 | 9 | 0 | Cystoscopy every 3 months for 2 years and every 6 months until 5 years and then annually | Urothelial papilloma, PULMP | ||
Gofrit O, 2008 [34] | 31/43 | Retrospective | 10 mm, negative UC | Ta/G1/G2 | 58.1 | 16.1 | 81.4 | 3.1% | 3.1 | 0 | Increase in number and/or size (62.8%), patient’s request (16.3%) | |||
Hernández V, 2009 [35] | 64/70 | Prospective | <10 mm <5 tumors and negative UC | Ta/T1/G1/G2 | NA | 38.6 | 10.3 | 75.8 | 16.2 | 6.5 | 0 | UC + cystoscopy every 4 months for 1 year, then alternating US and cystoscopy + UC every 6 months | Increase in number and/or size (58.6%), hematuria (4.3%), positive UC (2.9%) | History of HG carcinoma (G3), CIS or positive UC |
Hernández V, 2016 [36] | 186/252 | Prospective | Ta/T1/G1/G2 | 43 | 72 | 13.4 | 80.6 | 20.7 | 13.6 | 2.15 | UC + cystoscopy every 4 months for 2 years, followed by every 6 months (alternating cystoscopy and US) | Increase in number and/or size (61.9%), increase in number and/or size and positive UC (8.7%), positive UC (7.1%) | ||
Hurle R, 2016 [37] BIAS project | 55/70 | Prospective | Ta/T1a/G1/G2 | 96.4 | 53 | 12.5 | 51 | 18 | 13.2 | 0 | UC + cystoscopy every 3 months for 1 year, then every 6 months | Increase in number and/or size (53.8%), hematuria (32%), positive UC (14.3%) | ||
Hurle R, 2017 [38] BIAS project | 122/146 | Prospective | Ta/T1a/G1/G2 | 41.0 | 11.9 | 11 | 37.7 | 13.1 | 7.4 | 0 | Increase in number and/or size (64.4%), hematuria (18.6%), positive UC (16.9%) | History of HG carcinoma (G3), CIS or positive UC | ||
Hurle R, 2018 [39] BIAS project | 167/181 | Prospective | Ta/T1a/G1/G2 | 36.5% | 13 | 12 | 36.5 | NA | NA | 0 | Increase in number and/or size (22.1%), hematuria (6.1%), positive UC (5.5%) | |||
Contieri R, 2022 [25] BIAS project | 214/251 | Prospective | Ta/T1a/G1/G2 | 35.8% | 38.8 | 13 | 51.8 | NA | NA | 0.7 | Increase in number and/or size (87.7%), hematuria (2.3%), positive UC (8.5%) | |||
Lokeshwar SD, 2022 [40] | 45 | Retrospective | <5 lesions, <2 cm in prior TURBT, LGTa appearance | Ta/T1/G1/G2 | 58 | 62 | NA | 89 | 11 | 9 | 2.2 | Cystoscopy every 3–6 months | CIS or MIBC | |
Tan WS, 2023 [41] BIAS project | 163/208 | Prospective | ≤5 lesions, <1 cm in prior TURBT, LGTa appearance | Ta/T1/G1/G2 | NA | 33 | 66.9 | 6.1 | 2.5 | 0 | UC + cystoscopy every 3 months for 1 year, then every 6 months | Increase in number and/or size (81.7%), positive UC (6.3%) and hematuria (5.8%) |
Criterion | Characteristics for AS |
---|---|
Tumor size | ≤3 cm |
Number of tumors | ≤5 tumors |
Tumor appearance | Papillary |
Urinary cytology | Negative |
Previous pathology | No history of high-grade disease (G3) or carcinoma in situ (CIS) |
Symptoms | Absence of gross hematuria |
Follow-up compliance | Willing and able to adhere to cystoscopy follow-up |
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Campistol, M.; Lozano, F.; Carrion, A.; Raventós, C.X.; Morote, J.; Trilla, E. Active Surveillance in Non-Muscle Invasive Bladder Cancer: A Systematic Review. Cancers 2025, 17, 1714. https://doi.org/10.3390/cancers17101714
Campistol M, Lozano F, Carrion A, Raventós CX, Morote J, Trilla E. Active Surveillance in Non-Muscle Invasive Bladder Cancer: A Systematic Review. Cancers. 2025; 17(10):1714. https://doi.org/10.3390/cancers17101714
Chicago/Turabian StyleCampistol, Míriam, Fernando Lozano, Albert Carrion, Carles Xavier Raventós, Juan Morote, and Enrique Trilla. 2025. "Active Surveillance in Non-Muscle Invasive Bladder Cancer: A Systematic Review" Cancers 17, no. 10: 1714. https://doi.org/10.3390/cancers17101714
APA StyleCampistol, M., Lozano, F., Carrion, A., Raventós, C. X., Morote, J., & Trilla, E. (2025). Active Surveillance in Non-Muscle Invasive Bladder Cancer: A Systematic Review. Cancers, 17(10), 1714. https://doi.org/10.3390/cancers17101714