Evidence map›Paper›PMID 31753752›Full record

GuidelineEuropean urology2020

EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort

J Alfred Witjes, Marek Babjuk, Joaquim Bellmunt, H Maxim Bruins, Theo M De Reijke, Maria De Santis, Silke Gillessen, Nicholas James, Steven Maclennan, Juan Palou and 111 more

Erratum issuedAbstract readConsensus StatementPractice Guideline
PubMed Publisher
In one paragraph

Guideline in European urology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 89 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
89citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

89 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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  12. Observational
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29 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

121 authors.

J Alfred WitjesDepartment of Urology, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Fred.Witjes@radboudumc.nl.
Marek BabjukDepatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria.
Joaquim BellmuntIMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Harvard Medical School, Boston, Massachusetts, USA.
H Maxim BruinsDepartment of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
Theo M De ReijkeDepartment of Urology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands.
Maria De SantisDepartment of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Charité University Hospital, Berlin, Germany.
Silke GillessenDivision of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK; Division of Oncology and Haematology, Kantonsspital St Gallen, St Gallen, Switzerland; University of Bern, Bern, Switzerland.
Nicholas JamesUniversity Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
Steven MaclennanAcademic Urology Unit, University of Aberdeen, Aberdeen, UK.
Juan PalouDepartment of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain.
Tom PowlesThe Royal Free NHS Trust, London, UK; Barts Cancer Institute, Queen Mary University of London, London, UK.
Maria J RibalUro-Oncology Unit, Hospital Clinic, University of Barcelona, Spain.
Shahrokh F ShariatDepatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, New York, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Theo Van Der KwastDepartment of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands.
Evanguelos XylinasDepartment of Urology, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Paris Descartes University, Paris, France.
Neeraj AgarwalHuntsman Cancer Institute, University of Utah (NCI-CCC), Salt Lake City, Utah, USA.
Tom ArendsUrology Department, Canisius-Wilhelmina Ziekenhuis Nijmegen, The Netherlands.
Aristotle Bamias2nd Propaedeutic Dept of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Athens, Greece.
Alison BirtleDivision of Cancer Sciences, University of Manchester, Manchester, UK; Rosemere Cancer Centre, Lancashire Teaching Hospitals, Preston, UK.
Peter C BlackDepartment of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, British Colombia, Canada.
Bernard H BochnerDepartment of Urology, Weill Cornell Medical College, New York, New York, USA; Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Michel BollaEmeritus Professor of Radiation Oncology, Grenoble - Alpes University, Grenoble, France.
Joost L BoormansDepartment of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Alberto BossiDepartment of Radiation Oncology, Gustave Roussy Institute, Villejuif, France.
Alberto BrigantiDepartment of Urology, Urological Research Institute, Milan; Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
Iris BrummelhuisDepartment of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
Max BurgerDepartment of Urology, Caritas-St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
Daniel CastellanoMedical Oncology Department, 12 de Octubre University Hospital (CIBERONC), Madrid, Spain.
Richard CathomasDepartement Innere Medizin, Abteilung Onkologie und Hämatologie, Kantonsspital Graubünden, Chur, Switzerland.
Arturo ChitiDepartment of Biomedical Sciences, Humanitas University, Milan, Italy; Humanitas Research Hospital, Milan, Italy.
Ananya ChoudhuryDivision of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
Eva CompératDepartment of Pathology, Tenon hospital, HUEP, Paris, France; Sorbonne University, Paris, France.
Simon CrabbCancer Sciences Unit, University of Southampton, Southampton, UK.
Stephane CulineDepartment of Cancer Medicine, Hôpital Saint Louis, Paris, France.
Berardino De BariRadiation Oncology Department, Centre Hospitalier Régional Universitaire "Jean Minjoz" of Besançon, INSERM UMR 1098, Besançon, France; Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland.
Willem De BlokDepartment of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
Pieter J L De VisschereDepartment of Radiology and Nuclear Medicine, Division of Genitourinary Radiology and Mammography, Ghent University Hospital, Ghent, Belgium.
Karel DecaesteckerDepartment of Urology, Ghent University Hospital, Ghent, Belgium.
Konstantinos DimitropoulosDepartment of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
Jose L Dominguez-EscrigServicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
Stefano FantiDepartment of Nuclear Medicine, Policlinico S Orsola, University of Bologna, Italy.
Valerie FonteyneDepartment of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium.
Mark FrydenbergDepartment of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia.
Jurgen J FuttererDepartment of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Georgios GakisDepartment of Urology and Paediatric Urology, University Hospital of Würzburg, Julius-Maximillians University, Würzburg, Germany.
Bogdan GeavleteDepartment of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania.
Paolo GonteroDivision of Urology, Molinette Hospital, University of Studies of Torino, Torino, Italy.
Bernhard GrubmüllerDepartment of Urology, Medical University of Vienna, Vienna, Austria.
Shaista HafeezDivision of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK.
Donna E HanselDepartment of Urology, University of California, San Diego Pathology, La Jolla, California, USA.
Arndt HartmannInstitute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.
Dickon HayneDepartment of Urology, UWA Medical School, University of Western Australia, Perth, Australia.
Ann M HenryLeeds Institute of Medical Research, University of Leeds, Leeds, UK.
Virginia HernandezDepartment of Urology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain.
Harry HerrUrology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Ken HerrmannDepartment of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany.
Peter HoskinDivision of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK; Mount Vernon Centre for Cancer Treatment, London, UK.
Jorge HuguetDepartment of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain.
Barbara A Jereczek-FossaDepartment of Oncology and Hemato-oncology, University of Milan, Milan; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy.
Rob JonesInstitute of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Ashish M KamatDepartment of Urology - Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.
Vincent KhooDivision of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK; Department of Medicine, University of Melbourne; Monash University, Melbourne, Australia.
Anne E KiltieCRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK.
Susanne KregeDepartment of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany.
Sylvain LadoireDepartment of Medical Oncology, Centre Georges François Leclerc, Dijon, France.
Pedro C LaraDepartment of Oncology, Hospital Universitario San Roque; Universidad Fernando Pessoa, Canarias, Spain.
Annemarie LeliveldDepartment of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Estefania Linares-EspinósDepartment of Urology, University Hospital La Paz, Madrid, Spain.
Vibeke LøgagerDepartment of Radiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark.
Anja LorchDepartment of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland.
Yohann LoriotDépartement de Médecine Oncologique, Gustave Roussy, INSERM U981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
Richard MeijerUMC Utrecht Cancer Center, MS Oncologic Urology, Utrecht, The Netherlands.
M Carmen MirServicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
Marco MoschiniDepartment of Urology, Luzerner Kantonsspital, Luzern, Switzerland.
Hugh MostafidDepartment of Urology, Royal Surrey County Hospital, Guildford, UK.
Arndt-Christian MüllerDepartment of Radiation Oncology, Eberhard Karls University, Tübingen, Germany.
Christoph R MüllerCancer Treatment Centre, Sorlandet Hospital, Kristiansand, Norway.
James N'DowAcademic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
Andrea NecchiDepartment of Medical Oncology, Istituto Nazionale Tumori of Milan, Milan, Italy.
Yann NeuzilletDepartment of Urology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France.
Jorg R OddensDepartment of Urology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands.
Jan OldenburgDepartment of Oncology, Akershus University Hospital, Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
Susanne OsantoDepartment of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
Wim J G OyenDepartment of Biomedical Sciences, Humanitas University, Milan, Italy; Humanitas Research Hospital, Milan, Italy; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
Luís Pacheco-FigueiredoDepartment of Urology, Centro Hospitalar São João, Porto, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
Helle PappotDepartment of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
Manish I PatelDepartment of Urology, Westmead Hospital, University of Sydney, Sydney, Australia.
Bradley R PietersDepartment Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Karin PlassEAU Guidelines Office, Arnhem, The Netherlands.
Mesut RemziDepartment of Urology, Medical University of Vienna, Vienna, Austria.
Margitta RetzDepartment of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany.
Jonathan RichenbergDepartment of Imaging and Nuclear Medicine, Royal Sussex County Hospital, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK.
Michael RinkDepartment of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Florian RoghmannDepartment of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany.
Jonathan E RosenbergDepartment of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA.
Morgan RouprêtDepartment of Urology, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.
Olivier RouvièreHospices Civils de Lyon, Service d'Imagerie Urinaire et Vasculaire, Hôpital Edouard Herriot, Lyon, France; Université de Lyon, Université Lyon 1, faculté de médecine Lyon Est, Lyon, France.
Carl SalembierDepartment of Radiation Oncology, Europe Hospitals Brussels, Belgium.
Antti SalminenDepartment of Urology, University Hospital of Turku, Finland.
Paul SargosDepartment of Radiotherapy, Institut Bergonié, Bordeaux, France.
Shomik SenguptaDepartment of Surgery, Austin Health, University of Melbourne, Melbourne, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia.
Amir SherifDepartment of Surgical and Perioperative Sciences, Urology and Andrology, Umeå university, Umeå, Sweden.
Robert J SmeenkDepartment of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
Anita SmitsDepartment of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
Arnulf StenzlDepartment of Urology, Eberhard Karls University Tübingen, Tübingen, Germany.
George N ThalmannDepartment of Urology, Inselspital, Bern University Hospital, Bern, Switzerland.
Bertrand TombalDivision of Urology, IREC, Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium.
Baris TurkbeyMolecular Imaging Program, National Cancer Institute, Bethesda, Maryland, USA.
Susanne Vahr LauridsenDepartment of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Riccardo ValdagniDepartment of Oncology and Hemato-oncology, Università degli Studi di Milano, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Antoine G Van Der HeijdenDepartment of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
Hein Van PoppelDepartment of Urology, University Hospitals Leuven, Belgium.
Mihai D VartolomeiDepartment of Urology, Medical University of Vienna, Vienna, Austria; Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania.
Erik VeskimäeDepartment of Urology, Tampere University Hospital, Tampere, Finland.
Antoni VilasecaUro-Oncology Unit, Hospital Clinic, University of Barcelona, Spain.
Franklin A Vives RiveraClinica HematoOncologica Bonadona Prevenir, Universidad Metropolitana, Clinica Club de Leones, Barranquilla, Colombia.
Thomas WiegelDepartment of Radiation Oncology, University Hospital Ulm, Ulm, Germany.
Peter WiklundIcahn School of Medicine, Mount Sinai Health System New York City, New York, USA; Department of Urology, Karolinska Institutet, Stockholm, Sweden.
Andrew WilliamsDepartment of Urology, Auckland City Hospital, Auckland, New Zealand.
Richard ZigeunerDepartment of Urology, Medizinische Universität Graz, Graz, Austria.
Alan HorwichEmeritus Professor, The Institute of Cancer Research, London, UK.

Funding

Cancer Research UK 23279
6 · The paper itself

Abstract

backgroundAlthough guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.

objectiveTo bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.

designA steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts prior to voting during a consensus conference.

settingOnline Delphi survey and consensus conference.

participantsThe European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), and 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). RESULTS AND LIMITATIONS: Overall, 116 statements were included in the Delphi survey. Of these statements, 33 (28%) achieved level 1 consensus and 49 (42%) achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease, and the evolving role of checkpoint inhibitor therapy in metastatic disease.

conclusionsThese consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time when further evidence is available to guide our approach. PATIENT SUMMARY: This report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available.

Indexed as

HumansInternational CooperationNeoplasm StagingUrinary Bladder NeoplasmsBladder cancerConsensusDelphiDiagnosisFollow-upTreatment

Identifiers

PMID31753752

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