TY - JOUR
TI - Risk factors for residual disease at re-TUR in a large cohort of T1G3
patients
AU - Pisano, F.
AU - Gontero, P.
AU - Sylvester, R.
AU - Joniau, S. and
AU - Serretta, V
AU - Larre, S.
AU - Di Stasi, S.
AU - van Rhijn, B.
AU - Witjes,
AU - A.
AU - Grotenhuis, A.
AU - Colombo, R.
AU - Briganti, A.
AU - Babjuk, M.
AU - and Soukup, V
AU - Malmstrom, P. U.
AU - Irani, J.
AU - Malats, N. and
AU - Baniel, J.
AU - Mano, R.
AU - Cai, T.
AU - Cha, E.
AU - Ardelt, P. and
AU - Varkarakis, J.
AU - Bartoletti, R.
AU - Dalbagni, G.
AU - Shariat, S. F.
AU - and Xylinas, E.
AU - Karnes, R. J.
AU - Palou, J.
JO - Actas Urologicas Espanolas - English Edition
PY - 2021
VL - 45
TODO - 6
SP - 473-478
PB - ELSEVIER ESPANA SLU
SN - 2173-5786
TODO - 10.1016/j.acuro.2020.08.016
TODO - Non-muscle invasive bladder cancer; Re-transurethral resection of the
bladder; Residual disease; Recurrence; Progression
TODO - 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.
ER -