A prospective observational study to evaluate the role of restaging transurethral resection of bladder tumour in patients with non-muscle invasive bladder cancer
DOI:
https://doi.org/10.18203/2320-6012.ijrms20194980Keywords:
Carcinoma in situ, Non-muscle invasive bladder cancer, Transurethral resection of bladder tumour, Restaging transurethral resection of bladder tumourAbstract
Background: Transurethral resection of bladder tumour (TURBT) is the primary treatment modality for Non-muscle invasive bladder cancer (NMIBC). Restaging transurethral resection of bladder tumour (RETURBT) is indicated to reduce risk of residual disease and correct staging errors after primary TURBT. The aim of the study is to evaluate the risk of residual tumour and upstaging in NMIBC after TURBT and to investigate the risk factors for the same.
Methods: A prospective observational study was carried out over 4 years and 87 patients were included in the study. Patients with NMIBC underwent RETURBT after 2-6 weeks of primary TURBT. The incidence of residual tumour and upstaging in RETUBRT was correlated with various histopathological and morphological parameters in primary TURBT.
Results: Out of 87 patients, who underwent RETURBT, residual disease was present in 51 patients (58.6%) and upstaging occurred in 22 patients (25.2%).On univariate analysis, T1 stage (p=0.01), high grade (p=0.01), Carcinoma in situ(CIS) (p=0.01) and multifocality (p=0.05) were predictive for residual disease in RETURBT. High grade (p=0.01), CIS (p=0.01) and absence of detrusor muscle in specimen (p=0.03) were risk factors for upstaging in RETURBT.
Conclusions: NMIBC have high incidence of residual disease and upstaging after primary TURBT. T1 stage, high tumour grade, CIS, and multifocality are risk factors for residual disease after primary TURBT. High tumour grade, CIS and absence of detrusor muscle are strongly associated with upstaging during RETURBT.
Metrics
References
Ramírez-Backhaus M, Domínguez-Escrig J, Collado A, Rubio-Briones J, Solsona E. Restaging Transurethral Resection of Bladder Tumor for High-risk Stage Ta and T1 Bladder Cancer. Curr Uro Repo. 2012;13(2):109-14.
Jurewicz M, Soloway M. Approaching the optimal transurethral resection of a bladder tumor. J Urol. 2014;40(2):737.
Professionals S-O.EAU Guidelines: Non-muscle-invasive Bladder Cancer. Available at: http://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/#5 Accessed 10 June 2019.
Miladi M, Peyromaure M, Zerbib M, Saı̈ghi D, Debré B. The Value of a Second Transurethral Resection in Evaluating Patients with Bladder Tumours. Europ Urol. 2003;43(3):241-5.
Mersdorf A, Brauers A, Wolff JM, Schneider V, Jakse G. Second transurethral resection for superficial bladder cancer: a must? J Urol. 1998;159:43.
Herr H, Donat S. Quality control in transurethral resection of bladder tumours. BJU Internat. 2008;102(9b):1242-6.
Gill T, Das R, Dey R, Mitra S, Basu S. Predictive factors for residual tumor and tumor upstaging on relook transurethral resection of bladder tumor in non-muscle invasive bladder cancer. Urol Anna. 2014;6(4):305.
Ali M, Ismail I, Eltobgy A, Gobeish A. Evaluation of Second-Look Transurethral Resection in Restaging of Patients with Nonmuscle-Invasive Bladder Cancer. J Endourol. 2010;24(12):2047-50.
Heney NM, Nocks BN, Daly JJ, Blitzer PH, Parkhurst EC. Prognostic factors in carcinoma of the ureter. J Urol. 1981;125:632-6.
Wei X, Li F, Siddiqui K, Zhuang Q, Hu Z, Song X et al. Resection marginal width and positive margin of transurethral resection of bladder tumor are associated with bladder cancer early recurrence. Intern J Clini Experi Medi. 2016;9(11):21625-34.
Herr H. The value of a second transurethral resection in evaluating patients with bladder tumors. J Urol. 1999;162(1):74-6.
Divrik T, Yildirim Ü, Eroğlu A, Zorlu F, Özen H. Is a Second Transurethral Resection Necessary for Newly Diagnosed pT1 Bladder Cancer?. J Urol. 2006;175(4):1258-61.
Mahdy M, Badreldin M, Baky T, Salem S. Evaluation of second-look transurethral resection in the management of superficial bladder tumors. Men Medi J. 2016;29(3):722.
Dutta S, Smith J, Shappell S, Coffey C, Chang S, Cookson M. Clinical under staging of high risk nonmuscle invasive urothelial carcinoma treated with radical cystectomy. J Urol. 2001;166(2):490-3.
Freeman JA, Esrig D, Stein JP, Simoneau AR, Skinner EC, Chen SC, et al. Radical cystectomy for high risk patients with superficial bladder cancer in the era of orthotopic urinary reconstruction. Canc. 1995;76(5):833-9.
Kitamura H, Kakehi Y. Treatment and management of high-grade T1 bladder cancer: what should we do after second TUR? Japan J Clini Oncol. 2015;45(4):315-22.
Lee MC, Levin HS, Jones JS. The Role of Pathology Review of Transurethral Bladder Tumor Resection Specimens in the Modern Era. J Urol. 2010;183(3):921-8.
Jancke G, Rosell J, Jahnson S. Impact of surgical experience on recurrence and progression after transurethral resection of bladder tumour in non-muscle-invasive bladder cancer. Scand J Urol. 2013;48(3):276-83.
Grimm M, Steinhoff C, Simon X, Spiegelhalder P, Ackermann R, Vögeli T. Effect of Routine Repeat Transurethral Resection for Superficial Bladder Cancer: A Long-term Observational Study. J Urol. 2003;170(2):433-7.
Orsola A, Cecchini L, Raventã³S CX, Trilla E, Planas J, Landolfi S, et al. Risk factors for positive findings in patients with high-grade T1 bladder cancer treated with transurethral resection of bladder tumour (TUR) and bacilleCalmette-Guérin therapy and the decision for a repeat TUR. BJU Internat. 2010;105(2):202-7.
Devasia A, Kumar S, Kekre N, Katumalla F, Kumar R, Chacko N. Second transurethral resection in T1G3 bladder tumors - Selectively avoidable? Ind J Urol. 2011;27(2):176.
Rhijn BWV, Kwast THVD, Alkhateeb SS, Fleshner NE, Leenders GJV, Bostrom PJ, et al. A New and Highly Prognostic System to Discern T1 Bladder Cancer Substage. Europ Urol. 2012;61(2):378-84.