Efficacy and safety of active surveillance and chemoablation in the management of non-muscle invasive bladder cancer (NMIBC): Systematic review and pooled analysis by the European Association of Urology-Young Academic Urologists: Urothelial Carcinoma Working Group

Objective: To evaluate the oncological outcomes and safety of chemoablation and Active Surveillance for non-muscle invasive bladder cancer. Methods: A systematic review was performed by accessing the following bibliographic databases: PubMed, Scopus, Embase and the Cochrane central register of controlled trials were searched. Results: A total of 29 studies (1847 patients) met the inclusion criteria. The vast majority of patients included had Active Surveillance (n = 7, 582) and chemoablation (n = 21, 1265). Regarding chemoablation, Mitomycine C (MMC) was used in 14 studies, Epirubicin in 2 studies, Bacillus Calmette-Guerin (BCG) in one study and Gemcitabine in 5 studies (weekly or single dose). Follow-up ranged from 2 weeks to 39 months (Mean 16.8 months). The mean timing of initial assessment was 4.2 (range: 1 day to 27 weeks), and the pooled complete response (CR) rate was 52.3%. For the AS protocol, the pathological findings before observation were Ta (n = 583, 86%), low (n = 462, 60.1%) and high grade (n = 138, 42.1%). Mean follow up was 47 months ranged from 25 to 72 months, the mean duration of AS was 13.4 months. The mean AS failure rate was 64%. Grade progression, stage progression and progression to muscle-invasive bladder cancer (MIBC) were 68 (16.5%), 35 (8.5%) and 5 (1%) of cases, respectively. Conclusions: Patients with selected inclusion criteria based on the review can be referred for active Surveillance or chemoablation protocol, with a minimal risk of progression in either grade or stage for AS and a good complete response for chemoablation.