To the editor

摘要

To the Editor: We are in agreement with Lamm et al regarding the need for a new standard definition to describe progression of nonmuscle invasive bladder cancer (NMIBC). We, too, recognized that defining a state of progression before the development of muscle invasion would be a useful tool for clinical trials of patients with NMIBC. Consequently in 2005 we went through a similar process when writing the protocol for the West Midlands (United Kingdom) Bladder Cancer Prognosis Programme (BCPP, incorporating SELENIB [Selenium and Vitamin E Trial in Non-Muscle Invasive Bladder Cancer]), defining progression as "a recurrence with an increase in tumor grade from 1/2 to grade 3, or an increase in TNM stage, or the new occurrence of carcinoma in situ (CIS) in a bladder previously free from such lesions, or the new occurrence of multiple tumors following resection of a solitary tumor, or the need for a cystectomy because of refractory disease."1 Clearly there are many similarities between our definition of progression for the purposes of BCPP/SELENIB and that proposed by Lamm et al, and we support their rationale and endeavor. As we have observed with the change in terminology from "superficial bladder cancer" to "NMIBC" during approximately the last 10 years,2'3 the key to adoption is using a term that is universally applicable and acceptable. In BCPP/SELENIB we have always qualified our definition of progression by describing it as "biological progression." Perhaps "biological progression" is the term that best describes the new definition by Lamm et al.