Clinical Practice Guidelines for Bladder Cancer: A Systematic Review and Meta-Analysis Using the AGREE II Instrument

Abstract

<b><i>Context:</i></b> Numerous health care organizations have established guidelines on diagnosis and treatment of bladder cancer. However, the lack of a standardized guideline development approach results in considerable differences of the guidelines’ methodological quality. <b><i>Objective:</i></b> To assess the methodological quality of all relevant clinical practice guidelines (CPGs) for urinary bladder cancer and provide a reference for clinicians in choosing guidelines of high methodological quality. <b><i>Evidence Acquisition:</i></b> A systematic literature search was conducted in Medline via PubMed, 4 CPG databases, and 7 databases of interdisciplinary organizations. CPGs for non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) with the topics screening, pathology, diagnosis, treatment, and aftercare published in English language between 2012 and 2018 were included. The CPG quality was analyzed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. <b><i>Evidence Synthesis:</i></b> A total of 16 CPGs were included for the quality appraisal. Because of predefined criteria, 5 CPGs were “strongly recommended” (American Urological Association NMIBC, European Association of Urology [EAU] NMIBC, EAU MIBC, National Institute for Health and Care Excellence, and National Comprehensive Cancer Network), 4 CPGs were “weakly recommended” and 7 CPGs were “not recommended.” <b><i>Conclusions:</i></b> The methodological quality of bladder cancer guidelines is diverse. Considering the rapid development of new therapies (e.g., immune checkpoint inhibitors), “living guidelines” of high methodological quality, such as the EAU NMIBC or MIBC guideline, will become more relevant in the future guideline’s landscape.