Fujikawa Atsushi, Yumura Yasushi, Yao Masahiro, Tsuchiya Futoshi, Iwasaki Akira, Moriyama Masatoshi
Department of Urology, Yokohama City Municipal Hospital, Yokohama, Japan ; Department of Urology, Yokohama Minato Red Cross Hospital, Yokohama, Japan.
Indian J Urol. 2012 Jul;28(3):267-70. doi: 10.4103/0970-1591.102697.
Repeat transurethral resection (ReTUR) is an effective treatment for non-muscle-invasive bladder cancer (NMIBC) to prevent disease recurrence or progression. It also has an important role in stratifying patients according to histopathological results. Therefore, the end point of ReTUR should be considered in a treatment algorithm. We evaluated positive ReTUR to define its role in a treatment algorithm for NMIBC.
A second TUR was performed in 111 patients between July 2006 and February 2010. A third TUR was performed in 31 patients with T1/a/is tumors at the second TUR. The incidence of residual disease was calculated according to the NMIBC risk levels proposed by the International Bladder Cancer Group. We used ReTUR as a general term to indicate second and third TURs.
Residual disease at the second TUR was detected in 51% of the patients; it was observed in 17%, 45%, and 65% patients in the low-, intermediate-, and high-risk disease groups, respectively (P = 0.01). Residual disease at the third TUR was detected in 48% patients; it was observed in 18% and 65% patients in the intermediate- and high-risk disease groups, respectively (P = 0.06).
The incidence of residual disease correlated with the risk levels for NMIBC. In the intermediate-risk disease group, nearly complete resection was accomplished after the third TUR. However, in the high-risk disease group, a high incidence of residual disease was identified even after the third TUR. Our results provide important data that may be useful in establishing an end point in a treatment algorithm for NMIBC.
重复经尿道切除术（ReTUR）是预防非肌层浸润性膀胱癌（NMIBC）疾病复发或进展的有效治疗方法。它在根据组织病理学结果对患者进行分层方面也具有重要作用。因此，在治疗方案中应考虑ReTUR的终点。我们评估了阳性ReTUR以确定其在NMIBC治疗方案中的作用。
2006年7月至2010年2月期间，对111例患者进行了第二次经尿道切除术。对31例在第二次经尿道切除术中发现T1/a/is肿瘤的患者进行了第三次经尿道切除术。根据国际膀胱癌小组提出的NMIBC风险水平计算残留疾病的发生率。我们使用ReTUR作为通用术语来表示第二次和第三次经尿道切除术。
第二次经尿道切除术后，51%的患者检测到残留疾病；低、中、高风险疾病组中分别有17%、45%和65%的患者观察到残留疾病（P = 0.01）。第三次经尿道切除术后，48%的患者检测到残留疾病；中、高风险疾病组中分别有18%和65%的患者观察到残留疾病（P = 0.06）。
残留疾病的发生率与NMIBC的风险水平相关。在中风险疾病组中，第三次经尿道切除术后几乎实现了完全切除。然而，在高风险疾病组中，即使在第三次经尿道切除术后仍发现残留疾病的发生率很高。我们的结果提供了重要数据，可能有助于确定NMIBC治疗方案中的终点。
