The role of re-transurethral resection of bladder tumor in patients with TaHG non muscle invasive bladder cancer

被引:0
作者
Scilipoti, Pietro [1 ]
Moschini, Marco [1 ]
de Angelis, Mario [1 ]
Afferi, Luca [2 ]
Lonati, Chiara [3 ]
Longoni, Mattia [1 ]
Tremolada, Giovanni [1 ]
Zaurito, Paolo [1 ]
Viti, Alessandro [1 ]
Santangelo, Alfonso [1 ]
Pichler, Renate [4 ]
Necchi, Andrea [1 ]
Montorsi, Francesco [1 ]
Briganti, Alberto [1 ]
Mari, Andrea [5 ]
Krajewski, Wojciech [6 ]
Laukthina, Ekaterina [7 ]
Pradere, Benjamin [8 ]
Del Giudice, Francesco [9 ]
Mertens, Laura [10 ]
Gallioli, Andrea [11 ]
Soria, Francesco [12 ]
Gontero, Paolo [12 ]
Albisinni, Simone [13 ]
Shariat, Shahrokh F. [7 ,14 ,15 ,16 ,17 ]
Carando, Roberto [18 ,19 ,20 ]
机构
[1] IRCCS Osped San Raffaele Sci Inst, URI, Div Expt Oncol, Unit Urol, Via Olgettina 60, I-20132 Milan, Italy
[2] Luzerner Kantonsspital Lucerne, Dept Urol, Luzern, Switzerland
[3] Univ Brescia, Spedali Civili Hosp, Dept Urol, Brescia, Italy
[4] Med Univ Innsbruck, Dept Urol, Innsbruck, Austria
[5] Univ Florence, Careggi Hosp, Dept Urol, Florence, Italy
[6] Wroclaw Med Univ, Dept Urol & Oncol Urol, Wroclaw, Poland
[7] Med Univ Vienna, Vienna Gen Hosp, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
[8] La Croix Sud Hosp, Dept Urol UROSUD, Quint Fonsegrives, France
[9] Sapienza Univ, Dept Maternal Infant & Urol Sci, Umberto I Polyclin Hosp, Rome, Italy
[10] Netherlands Canc Inst, Dept Urol, NL-1066 CX Amsterdam, Netherlands
[11] Autonomous Univ Barcelona, Dept Urol, Fdn Puigvert, Barcelona, Spain
[12] Torino Sch Med, Dept Surg Sci, Div Urol, Turin, Italy
[13] Univ Tor Vergata, Dept Urol, Rome, Italy
[14] Univ Texas Southwestern, Dept Urol, Dallas, TX USA
[15] Karl Landsteiner Inst Urol & Androl, Vienna, Austria
[16] Weill Cornell Med Coll, Dept Urol, New York, NY USA
[17] Charles Univ Prague, Fac Med 2, Dept Urol, Prague, Czech Republic
[18] Clin Luganese Moncucco, Lugano, Switzerland
[19] St Anna Clin, Swiss Med Grp, Sorengo, Switzerland
[20] Luzerner Kantonsspital, Belegarzt Urol, Luzern, Switzerland
关键词
Ta high grade; Non muscle invasive bladder cancer; Re-transurethral resection of bladder tumor; Recurrence; Progression; CARCINOMA IN-SITU; UROTHELIAL CARCINOMA; DIAGNOSIS; MANAGEMENT;
D O I
10.1007/s00345-024-05342-1
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose There is lack of evidence regarding the indication for re-transurethral resection of bladder tumor (reTURBT) for Ta high grade (HG) non-muscle invasive bladder cancer (NMIBC). This study aims to evaluate the oncological outcomes of patients with TaHG NMIBC to determine the benefit from performing reTURBT. Methods We relied on a multicenter cohort of 317 TaHG NMIBC from 12 centers who underwent TURBT and a subsequent complete Bacillus Calmette-Gu & eacute;rin induction from 2009 to 2021. Kaplan Meier analyses estimated recurrence free survival (RFS) and progression free survival (PFS) according to reTURBT. Sub-analyses evaluated PFS in patients with multiple risk factors indicating necessity for reTURBT according to international guidelines (multifocality, size > 3 cm, recurrent cancer, carcinoma in situ, lymph vascular invasion, histological variant, incomplete and absence of muscle layer at index TURBT). Multivariable cox-regression analysis predicted recurrence and progression. Results Of the 317 patients, 123 (39%) underwent reTURBT, while 194 (61%) did not. Residual disease was detected in 46% of cases, with a 3.2% upstaging rate. Median follow-up was 30 months. The 3-year RFS was higher in patients who underwent reTURBT (79% vs. 58%, p < 0.001), but no significant difference was observed in PFS. ReTURBT reduced the risk of recurrence [multivariable hazard ratio: 0.45, 95% Confidence interval (CI) 0.29-0.71]. Among patients who did not undergo reTURBT, those with >= 2 risk factors had lower 3-year PFS (73% vs. 92%, p < 0.001) than those with 0-1 risk factor, whereas no difference in 3-year PFS was observed in patients who underwent reTURBT regardless of the number of risk factors (85% vs. 87%, p = 0.8). Conclusion ReTURBT demonstrated efficacy in reducing recurrence among patients with TaHG NMIBC, yet its impact on progression remained uncertain. Our study underscores the importance of adhering to current international guidelines, particularly for patients with multiple risk factors indicating necessity for reTURBT.
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页数:9
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