Prognostic factors of early second transurethral resection of non-muscle invasive bladder cancer − 10 years of experience of a referral center
Authors:
B. Žemličková; A. Brisuda
Authors‘ workplace:
Urologická klinika 2. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha
Published in:
Rozhl. Chir., 2022, roč. 101, č. 3, s. 119-128.
Category:
Original articles
doi:
https://doi.org/10.33699/PIS.2022.101.3.119–128
Overview
Introduction: Urothelial bladder cancer invading the submucosal layer (T1) is a tumor with a high risk of progression to invasive disease. In case of pT1 histology or absence of detrusor muscle in the specimen, an early second resection of the bladder tumor (reTUR) is indicated. According to retrospective studies, the histology finding of reTUR has a prognostic value. The aim of this study is to present the outcomes of second resection at a tertiary referral center.
Methods: In total, 146 patients with non-muscle invasive bladder cancer (NMIBC) were analyzed retrospectively. These patients underwent (the first) transurethral resection of their bladder tumor and an early reTUR between 3/2010 and 2/2021. Recurrence, progression and cystectomy free survival rates (RFS, PFS, CFS) were calculated using the Kaplan-Meier curves and the correlation of 7 clinical and pathologic factors (age, gender, muscle in specimen, presence of residual tumor and carcinoma in situ in reTUR, intravesical chemotherapy and BCG therapy) was evaluated using univariate and multivariate analyses.
Results: Median RFS was 2.15 years, 1-year RFS was 66.9% and 3-year RFS was 43.4%. One-year and 3-year PFS was 93.5% and 88.4%, respectively. One-year and 3-year CFS was 91.0% and 82.4%, respectively. Based on the multivariate analysis, presence of any residual tumor in reTUR was a negative prognostic marker for RFS, while intravesical chemotherapy and BCG therapy were positive prognostic markers. Presence of any residual tumor in reTUR was the only negative prognostic marker for PFS and CFS.
Conclusion: The quality of the first resection of bladder tumor as determined by its completeness and presence of detrusor muscle in the histology specimen is the cornerstone of an adequate diagnosis and proper treatment. If an early reTUR is indicated, presence of any residual tumor in the histology specimen is a significant prognostic marker according to our findings.
Keywords:
urothelial carcinoma – Prognosis – Bladder cancer – early second resection (reTUR)
Sources
1. Mužík J, Dušek L, Babjuk M, et al. Uroweb – webový portál pro analýzu a vizualizaci epidemiologie, diagnostiky a léčby urologických malignit [online]. Masarykova univerzita, Brno 2022. [cit. 2021-06-02]. Available at: www: http://www.uroweb. cz. ISSN 1804-6371. Verze 1.6d.
2. Sylvester RJ, van der Meijden AP, Oosterlinck W, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006 Mar;49(3):466−465; discussion 475−477. doi:10.1016/j.eururo. 2005.12.031. Epub 2006 Jan 17. PMID: 16442208.
3. Sylvester RJ, Rodríguez O, Hernández V, et al. European Association of Urology (EAU) prognostic factor risk groups for non-muscle-invasive bladder cancer (NMIBC) incorporating the WHO 2004/2016 and WHO 1973 classification systems for grade: An update from the EAU NMIBC guidelines panel. Eur Urol. 2021 Apr;79(4):480−488. doi: 10.1016/j. eururo.2020.12.033. Epub 2021 Jan 6. PMID: 33419683.
4. Babjuk M, Burger M, Compérat E, et al. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ) Edn. Presented at the EAU Annual Congress Milan 2021. ISBN 978-94-92671-13-4. Publisher: EAU Guidelines Office. Place published: Arnhem, The Netherlands.
5. Soria F, D’Andrea D, Moschini M, et al. Predictive factors of the absence of residual disease at repeated transurethral resection of the bladder. Is there a possibility to avoid it in well-selected patients? Urol Oncol. 2020 Mar;38(3):77.e1−77.e7. doi:10.1016/j.urolonc.2019.08.010. Epub 2019 Sep 14. PMID: 31526650.
6. Fritsche HM, Burger M, Svatek RS, et al. Characteristics and outcomes of patients with clinical T1 grade 3 urothelial carcinoma treated with radical cystectomy: results from an international cohort. Eur Urol. 2010 Feb;57(2):300−309. doi:10.1016/j.eururo.2009.09.024. Epub 2009 Sep 12. Erratum in: Eur Urol. 2015 Jul;68(1):171. PMID: 19766384.
7. Dutta SC, Smith JA Jr, Shappell SB, et al. Clinical under staging of high risk nonmuscle invasive urothelial carcinoma treated with radical cystectomy. J Urol. 2001 Aug;166(2):490−493. PMID: 11458053.
8. Gontero P, Sylvester R, Pisano F, et al. The impact of re-transurethral resection on clinical outcomes in a large multicentre cohort of patients with T1 high-grade/ grade 3 bladder cancer treated with bacille Calmette-Guérin. BJU Int. 2016 Jul;118(1):44−52. doi:10.1111/bju.13354. Epub 2015 Nov 6. PMID: 26469362
9. Naselli A, Hurle R, Paparella S, et al. Role of restaging transurethral resection for T1 non-muscle invasive bladder cancer: A systematic review and meta-analysis. Eur Urol Focus. 2018 Jul;4(4):558−567. doi:10.1016/j.euf.2016.12.011. Epub 2017 Jan 13. PMID: 28753839.10.
10. Mariappan P, Zachou A, Grigor KM. Edinburgh Uro-Oncology Group. Detrusor muscle in the first, apparently complete transurethral resection of bladder tumour specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience. Eur Urol. 2010 May;57(5):843−849. doi:10.1016/j.eururo. 2009.05.047. Epub 2009 Jun 6. PMID: 19524354.
11. Mariappan P, Finney SM, Head E, et al. Edinburgh Urological Cancer Group. Good quality white-light transurethral resection of bladder tumours (GQ-WLTURBT) with experienced surgeons performing complete resections and obtaining detrusor muscle reduces early recurrence in new non-muscle-invasive bladder cancer: validation across time and place and recommendation for benchmarking. BJU Int. 2012 Jun;109(11):1666−1673. doi:10.1111/j.1464-410X.2011.10571.x. Epub 2011 Nov 1. PMID: 22044434.
12. Palou J, Pisano F, Sylvester R, et al. Recurrence, progression and cancer-specific mortality according to stage at re-TUR in T1G3 bladder cancer patients treated with BCG: not as bad as previously thought. World J Urol. 2018 Oct;36(10):1621−1627. doi:10.1007/ s00345-018-2299-2. Epub 2018 May 2. PMID: 29721611; PMCID: PMC8177015.
13. Bishr M, Lattouf JB, Latour M, et al. Tumour stage on re-staging transurethral resection predicts recurrence and progression-free survival of patients with high-risk non-muscle invasive bladder cancer. Can Urol Assoc J. 2014 May;8(5−6):E306-10. doi:10.5489/ cuaj.1514. PMID: 24940455; PMCID: PMC4039592.
14. Hashine K, Ide T, Nakashima T, et al. Results of second transurethral resection for high-grade T1 bladder cancer. Urol Ann. 2016 Jan-Mar;8(1):10−15. doi:10.4103/0974-7796.163798. PMID: 26834394; PMCID: PMC4719498.
15. Kramer MW, Rassweiler JJ, Klein J, et al. En bloc resection of urothelium carcinoma of the bladder (EBRUC): a European multicenter study to compare safety, efficacy, and outcome of laser and electrical en bloc transurethral resection of bladder tumor. World J Urol. 2015 Dec;33(12):1937−1943. doi:10.1007/ s00345-015-1568-6. Epub 2015 Apr 25. PMID: 25910478.
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