Shen Yi-jun, Ye Ding-wei, Yao Xu-dong, Zhang Shi-lin, Dai Bo, Zhu Yi-ping, Zhang Hai-liang, Zhu Yao, Shi Guo-hai, Ma Chun-guang
Department of Urology, Cancer Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Wai Ke Za Zhi. 2009 May 15;47(10):725-7.
To investigate the efficacy of repeat transurethral resection of tumor in patients with non-muscle invasive bladder cancer.
From March 2004 to August 2008, 462 patients (350 males, 112 females, aged from 35 to 83 years old) with non-muscle invasive bladder cancer, were evaluated according to tumor stage, grade and muscle or no muscle tissue in initial transurethral resected sample. One hundred and twenty-five patients underwent repeat transurethral resection of bladder tumor within 4 to 6 weeks after initial resection. Of these 125 patients 49 were Ta, 76 were T1, 58 were low grade carcinoma, 67 were high grade carcinoma and 30 were not found presence of muscle tissue in initial resected sample in patients with T1 stage.
Of the 125 cases, 34.4% (43/125) had residual tumor and 65.6% (82/125) had no tumor on repeat transurethral resection. Of 43 cases with residual tumor 35 had non-muscle invasive tumor including 15 in Ta and 20 in T1. The patients with high grade carcinoma had more residual tumor than those with low grade carcinoma (P < 0.05). The patients with muscle tissue in initial transurethral resected sample had fewer residual tumor than those without (P < 0.05). Twelve cases (9.6%) were understated at initial resection. Six cases (4.8%) had bladder perforation and 7 (5.6%) had bleeding during repeat transurethral resection. All cases were followed up for 3 to 56 months (median 26 months), 37.2% (16/43) patients with residual tumor in repeat transurethral resection had recurrence while only 12.2% (10/82) without residual tumor in repeat transurethral resection did (P < 0.05).
Routine repeat transurethral resection is advised to non-muscle invasive bladder cancer patients with T1 tumor or high grade carcinoma or no muscle tissue in initial transurethral resected sample within 4 to 6 weeks after initial resection. Repeat transurethral resection could increases the stage accuracy.
探讨重复经尿道肿瘤切除术治疗非肌层浸润性膀胱癌患者的疗效。
2004年3月至2008年8月，462例（男性350例，女性112例，年龄35至83岁）非肌层浸润性膀胱癌患者，根据肿瘤分期、分级以及初次经尿道切除标本中有无肌肉组织进行评估。125例患者在初次切除术后4至6周内行重复经尿道膀胱肿瘤切除术。这125例患者中，Ta期49例，T1期76例，低级别癌58例，高级别癌67例，T1期患者初次切除标本中未发现肌肉组织的有30例。
125例患者中，重复经尿道切除术后34.4%（43/125）有残留肿瘤，65.6%（82/125）无肿瘤残留。43例有残留肿瘤的患者中，35例为非肌层浸润性肿瘤，其中Ta期15例，T1期20例。高级别癌患者的残留肿瘤比低级别癌患者多（P<0.05）。初次经尿道切除标本中有肌肉组织的患者残留肿瘤比无肌肉组织的患者少（P<0.05）。12例（9.6%）在初次切除时分期低估。6例（4.8%）在重复经尿道切除术中发生膀胱穿孔，7例（5.6%）发生出血。所有病例随访3至56个月（中位26个月），重复经尿道切除术中残留肿瘤的患者有37.2%（16/43）复发，而重复经尿道切除术中无残留肿瘤的患者仅有12.2%（10/82）复发（P<0.05）。
建议对初次经尿道切除标本为T1期肿瘤、高级别癌或无肌肉组织的非肌层浸润性膀胱癌患者在初次切除术后4至6周内行常规重复经尿道切除术。重复经尿道切除术可提高分期准确性。
