Department of Medical-Surgical Specialties and Public Health, Urology Section, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, Perugia, Italy.
J Endourol. 2011 Nov;25(11):1703-12. doi: 10.1089/end.2011.0081. Epub 2011 Sep 21.
Transurethral resection of the bladder (TURB), the first step in treatment of patients with urothelial bladder cancers, is limited by technicalities, surgeon skill, and random chance. When high-risk superficial diseases are discovered, a repeated TURB is indicated. We reviewed current literature and performed a meta-analysis of the role of repeated TURB in the management of nonmuscle-invasive bladder cancers.
PubMed, MEDLINE, ISI Web of Knowledge, EBSCO, EMBASE, and Biomed Central databases were searched for reports in English from 1980 to June 2010. The end point was prevalence of persistent urothelial bladder cancer of any stage and grade at repeated TURB, assessed separately for T(a) and T(1) lesions at TURB. Persistence was presence at repeated TURB of same or lower stage cancer as at TURB; upstaging was presence of higher stage.
There were 2327 original articles and 562 reviews retrieved. Data from 15 studies were pooled and analyzed. Prevalence of T(1) was reported in all and of T(a) in 8. Persistence rate prevalence at repeated TURB was 0.39 (95% confidence interval [CI]=0.26 to 0.54) for T(a) and 0.47 (95% CI=0.41 to 0.53) for T(1). Persistence was 19.4% to 56% and 15.2% to 55%, and upstaging occurred in 0% to 14.3% of T(a) and 0% to 24.4% of T(1) at repeated TURB, respectively.
High percentages of persistence and upstaging confirm a repeated TURB is needed in patients with high-risk nonmuscle-invasive bladder cancer. Further investigation is encouraged taking risk stratification into consideration to evaluate the role of repeated TURB in low- and mid- risk diseases.
经尿道膀胱肿瘤切除术（TURB）是治疗尿路上皮膀胱癌患者的第一步，它受到技术、外科医生技能和偶然因素的限制。当发现高危表浅性疾病时，需要重复 TURB。我们回顾了目前的文献，并对重复 TURB 在非肌肉浸润性膀胱癌治疗中的作用进行了荟萃分析。
检索了 1980 年至 2010 年 6 月发表的英文文献，检索数据库包括 PubMed、MEDLINE、ISI Web of Knowledge、EBSCO、EMBASE 和 Biomed Central。终点是在重复 TURB 时任何阶段和分级的持续性尿路上皮膀胱癌的流行率，分别评估 TURB 时 T(a)和 T(1)病变的流行率。持续性是指在重复 TURB 时存在与 TURB 相同或较低阶段的癌症；升级是指更高阶段的存在。
共检索到 2327 篇原始文章和 562 篇综述。对 15 项研究的数据进行了汇总和分析。所有研究均报道了 T(1)的流行率，8 项研究报道了 T(a)的流行率。在重复 TURB 时，T(a)的流行率为 0.39（95%置信区间[CI]=0.26 至 0.54），T(1)的流行率为 0.47（95% CI=0.41 至 0.53）。在重复 TURB 时，T(a)的持续性为 19.4%至 56%，T(1)的持续性为 15.2%至 55%，T(a)的升级率为 0%至 14.3%，T(1)的升级率为 0%至 24.4%。
高比例的持续性和升级率证实，高危非肌肉浸润性膀胱癌患者需要重复 TURB。鼓励进一步研究考虑风险分层，以评估重复 TURB 在低风险和中风险疾病中的作用。
