Τίτλος:
Risk factors for residual disease at re-TUR in a large cohort of T1G3
patients
Περίληψη:
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.
Συγγραφείς:
Pisano, F.
Gontero, P.
Sylvester, R.
Joniau, S. and
Serretta, V
Larre, S.
Di Stasi, S.
van Rhijn, B.
Witjes,
A.
Grotenhuis, A.
Colombo, R.
Briganti, A.
Babjuk, M.
and Soukup, V
Malmstrom, P. U.
Irani, J.
Malats, N. and
Baniel, J.
Mano, R.
Cai, T.
Cha, E.
Ardelt, P. and
Varkarakis, J.
Bartoletti, R.
Dalbagni, G.
Shariat, S. F.
and Xylinas, E.
Karnes, R. J.
Palou, J.
Περιοδικό:
Actas Urologicas Espanolas - English Edition
Εκδότης:
ELSEVIER ESPANA SLU
Λέξεις-κλειδιά:
Non-muscle invasive bladder cancer; Re-transurethral resection of the
bladder; Residual disease; Recurrence; Progression
DOI:
10.1016/j.acuro.2020.08.016
