Department of Urology, Inje University Busan Paik Hospital, Busan, Korea.
J Endourol. 2012 Aug;26(8):1059-64. doi: 10.1089/end.2011.0576. Epub 2012 Apr 30.
Current guidelines recommend routine second transurethral resection (TUR) for accurate diagnosis and to prevent understaging of muscle-invasive bladder cancer. We evaluated the diagnostic accuracy of immediate second resection of the tumor bed during initial TUR and its prognostic significance.
Patients (n=126) undergoing TUR were prospectively randomized to undergo (n=63) or not undergo (n=63) immediate second resection of the tumor bed after complete TUR. Second resection was repeated until muscularis propria (MP) was identified in the specimen and the depth of tumor invasion was inspected. The results of second resection were compared with final pathology results for diagnostic accuracy. Recurrence and progression rates were compared in the two groups, and factors affecting recurrence were evaluated.
Patient age, sex distribution, number of tumors, pathologic T stage and grade were similar in the groups. MP was included in all TUR specimens in the immediate second resection group, compared with 41 of 63 (65.1%) in the nonsecond resection group. The concordance rate of second resection with final pathology was r=0.810 (P<0.01). The sensitivity and specificity of second resection for T(2) disease were 90.9% and 98.0%, respectively, and the positive and negative predictive values of second resection for T(2) disease were 90.0% and 96.2%, respectively. Among the 94 patients followed up, those in the second resection group had significantly higher 2-year recurrence-free survival rate (77.0% vs 45.8%, P=0.025), but there was no difference in progression-free survival rate.
Immediate second resection of the tumor bed after complete TUR improves the effectiveness of resection by immediately confirming the presence of MP in the specimen and accurately differentiating muscle-invasive disease. The advantages of immediate second resection were precise prediction of final pathology results and reduced early recurrence.
目前的指南建议对膀胱癌患者进行常规二次经尿道切除术（TUR），以获得准确的诊断并避免低估肌层浸润性膀胱癌。我们评估了初始 TUR 后即刻行肿瘤床二次切除术的诊断准确性及其预后意义。
前瞻性地将 126 例行 TUR 的患者随机分为两组，一组（n=63）行即刻行肿瘤床二次切除术，另一组（n=63）不行即刻行肿瘤床二次切除术。第二次切除重复进行，直至标本中可见到肌肉层（MP）并检查肿瘤侵犯的深度。比较两组的第二次切除结果与最终病理结果，以评估诊断准确性。比较两组的复发率和进展率，并评估影响复发的因素。
两组患者的年龄、性别分布、肿瘤数量、病理 T 分期和分级相似。即刻二次切除术组的所有 TUR 标本中均包括 MP，而非二次切除术组中有 41 例（65.1%）包括 MP。第二次切除与最终病理的一致性率 r=0.810（P<0.01）。第二次切除对 T2 疾病的灵敏度和特异度分别为 90.9%和 98.0%，阳性和阴性预测值分别为 90.0%和 96.2%。在 94 例随访患者中，二次切除术组的 2 年无复发生存率显著更高（77.0% vs. 45.8%，P=0.025），但无进展生存率无差异。
在完成 TUR 后即刻行肿瘤床二次切除术可通过立即确认标本中存在 MP 并准确区分肌层浸润性疾病，从而提高切除效果。即刻行肿瘤床二次切除术的优势在于能更准确地预测最终病理结果并降低早期复发率。
