Abstract
IntroductionTo assess the rate and location of residual tumor in re-transurethral resection of bladder tumor (re-TURBT) and develop a risk stratification tool to assist clinicians in making treatment decisions.Patients and MethodsThe data of 144 patients with high-risk bladder cancer who received re-TURBT were retrospectively reviewed. The rate and location of residual tumors was recorded. Logistic regression was performed to explore risk factors for residual tumors, and a risk classification tool was developed.ResultsAmong the 144 patients, the rates of residual tumor and tumor location at the base of the primary tumor were 22.2% and 10.4%, respectively. Non-urothelial carcinoma subspecialist, piecemeal resection and the absence of detrusor muscle in the first specimen were defined as risk factors. Patients were categorized into low-, intermediate-, and high-risk groups according to the number of risk factors. The rate of residual tumor in the high-risk group was significantly higher than that in the low- and intermediate-risk groups (50% vs. 7.8%, P=0.001; 50% vs. 18.6%, P=0.002). Moreover, high-risk patients benefitted more from a second resection at the base of the primary tumor due to the high rate of residual tumor located at this site than low- and intermediate-risk patients (23.5% vs. 2.0%, P=0.002; 23.5% vs. 10.2%, P=0.083).ConclusionsRisk stratification based on the subspecialist category, operative method, and presence or absence of detrusor muscle in the first specimen could help identify patients who benefit from re-TURBT and second resection the base of the primary tumor.
Highlights
To assess the rate and location of residual tumor in re-transurethral resection of bladder tumor and develop a risk stratification tool to assist clinicians in making treatment decisions
The inclusion criteria were as follows: [1] met the indications for reTURBT according to the European Association of Urology (EAU) or the American Urological Association guidelines [9, 14]; [2] the re-Transurethral resection of bladder tumor (TURBT) included the resection of all visible tumors and areas with a scar, oedema and the base of the primary tumor; [3] re-TURBT were performed by Baseline Characteristics of the Patients
detrusor muscle (DM) was present in the first TURBT specimen in 45 patients
Summary
To assess the rate and location of residual tumor in re-transurethral resection of bladder tumor (re-TURBT) and develop a risk stratification tool to assist clinicians in making treatment decisions. Transurethral resection of bladder tumor (TURBT) followed by intravesical adjuvant chemotherapy or immunotherapy is the standard diagnostic and treatment method for non-muscle invasive bladder cancer (NMIBC) [3, 4]. TURBT represents a challenge for urologists due to the high incidence of residual tumors [5, 6]. Residual tumor following TURBT has been considered to be partly responsible for recurrence [8], and the European Association of Urology (EAU) guidelines recommend reTURBT for patients with high-risk BCa [9]. Re-TURBT may impose an additional economic and emotional burden on patients, and a second resection at the base of the primary tumor will increase the risk of bladder perforation, especially for women [10]
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