@article{3029817,
    title = "Risk factors for residual disease at re-TUR in a large cohort of T1G3
patients",
    author = "Pisano, F. and Gontero, P. and Sylvester, R. and Joniau, S. and and Serretta, V and Larre, S. and Di Stasi, S. and van Rhijn, B. and Witjes, and A. and Grotenhuis, A. and Colombo, R. and Briganti, A. and Babjuk, M. and and Soukup, V and Malmstrom, P. U. and Irani, J. and Malats, N. and and Baniel, J. and Mano, R. and Cai, T. and Cha, E. and Ardelt, P. and and Varkarakis, J. and Bartoletti, R. and Dalbagni, G. and Shariat, S. F. and and Xylinas, E. and Karnes, R. J. and Palou, J.",
    journal = "Actas Urologicas Espanolas - English Edition",
    year = "2021",
    volume = "45",
    number = "6",
    pages = "473-478",
    publisher = "ELSEVIER ESPANA SLU",
    issn = "2173-5786",
    doi = "10.1016/j.acuro.2020.08.016",
    keywords = "Non-muscle invasive bladder cancer; Re-transurethral resection of the
bladder; Residual disease; Recurrence; Progression",
    abstract = "Introduction and objectives: The goals of transurethral resection of a
bladder tumor (TUR) are to completely resect the lesions and to make a
correct diagnosis in order to adequately stage the patient. It is well
known that the presence of detrusor muscle in the specimen is a
prerequisite to minimize the risk of under staging.
Persistent disease after resection of bladder tumors is not uncommon and
is the reason why the European Guidelines recommended a re-TUR for all
T1 tumors. It was recently published that when there is muscle in the
specimen, re-TUR does not influence progression or cancer specific
survival.
We present here the patient and tumor factors that may influence the
presence of residual disease at re-TUR. Material and methods: In our
retrospective cohort of 2451 primary T1G3 patients initially treated
with BCG, pathology results for 934 patients (38.1%) who underwent
re-TUR are available. 74% had multifocal tumors, 20% of tumors were
more than 3 cm in diameter and 26% had concomitant CIS.
In this subgroup of patients who underwent re-TUR, there was no residual
disease in 267 patients (29%) and residual disease in 667 patients
(71%): Ta in 378 (40%) and T1 in 289 (31%) patients. Age, gender,
tumor status (primary/recurrent), previous intravesical therapy, tumor
size, tumor multi-focality, presence of concomitant CIS, and muscle in
the specimen were analyzed in order to evaluate risk factors of residual
disease at re-TUR, both in univariate analyses and multivariate logistic
regressions.
Results: The following were not risk factors for residual disease: age,
gender, tumor status and previous intravesical chemotherapy. The
following were univariate risk factors for presence of residual disease:
no muscle in TUR, multiple tumors, tumors >= 3 cm, and presence of
concomitant CIS. Due to the correlation between tumor multi-focality and
tumor size, the multivariate model retained either the number of tumors
or the tumor diameter (but not both), p < 0.001. The presence of muscle
in the specimen was no longer significant, while the presence of CIS
only remained significant in the model with tumor size, p < 0.001.
Conclusions: The most significant factors for a higher risk of residual
disease at re-TUR in T1G3 patients are multifocal tumors and tumors more
than 3 cm. Patients with concomitant CIS and those without muscle in the
specimen also have a higher risk of residual disease. (C) 2021 AEU.
Published by Elsevier Espana, S.L.U. All rights reserved."
}