Gontero Paolo, Sylvester Richard, Pisano Francesca, Joniau Steven, Oderda Marco, Serretta Vincenzo, Larré Stéphane, Di Stasi Savino, Van Rhijn Bas, Witjes Alfred J, Grotenhuis Anne J, Colombo Renzo, Briganti Alberto, Babjuk Marek, Soukup Viktor, Malmström Per-Uno, Irani Jacques, Malats Nuria, Baniel Jack, Mano Roy, Cai Tommaso, Cha Eugene K, Ardelt Peter, Vakarakis John, Bartoletti Riccardo, Dalbagni Guido, Shariat Shahrokh F, Xylinas Evanguelos, Karnes Robert J, Palou Joan
Urology Clinic, Città della Salute e della Scienza di Torino, University of Studies of Turin, Turin, Italy.
Formerly Department of Biostatistics, EORTC Headquarters, Brussels, Belgium.
BJU Int. 2016 Jul;118(1):44-52. doi: 10.1111/bju.13354. Epub 2015 Nov 6.
To determine if a re-transurethral resection (TUR), in the presence or absence of muscle at the first TUR in patients with T1-high grade (HG)/Grade 3 (G3) bladder cancer, makes a difference in recurrence, progression, cancer specific (CSS) and overall survival (OS).
In a large retrospective multicentre cohort of 2451 patients with T1-HG/G3 initially treated with bacille Calmette-Guérin, 935 (38%) had a re-TUR. According to the presence or absence of muscle in the specimen of the primary TUR, patients were divided in four groups: group 1 (no muscle, no re-TUR), group 2 (no muscle, re-TUR), group 3 (muscle, no re-TUR) and group 4 (muscle, re-TUR). Clinical outcomes were compared across the four groups.
Re-TUR had a positive impact on recurrence, progression, CSS and OS only if muscle was not present in the primary TUR specimen. Adjusting for the most important prognostic factors, re-TUR in the absence of muscle had a borderline significant effect on time to recurrence [hazard ratio (HR) 0.67, P = 0.08], progression (HR 0.46, P = 0.06), CSS (HR 0.31, P = 0.07) and OS (HR 0.48, P = 0.05). Re-TUR in the presence of muscle in the primary TUR specimen did not improve the outcome for any of the endpoints.
Our retrospective analysis suggests that re-TUR may not be necessary in patients with T1-HG/G3, if muscle is present in the specimen of the primary TUR.
确定对于T1期高级别（HG）/3级（G3）膀胱癌患者，首次经尿道膀胱肿瘤切除术（TUR）时有无肌层，再次TUR是否会对复发、进展、癌症特异性生存（CSS）和总生存（OS）产生影响。
在一个大型回顾性多中心队列中，2451例最初接受卡介苗治疗的T1-HG/G3患者，935例（38%）接受了再次TUR。根据初次TUR标本中有无肌层，患者分为四组：1组（无肌层，未行再次TUR）、2组（无肌层，行再次TUR）、3组（有肌层，未行再次TUR）和4组（有肌层，行再次TUR）。比较四组的临床结局。
仅当初次TUR标本中无肌层时，再次TUR对复发、进展、CSS和OS有积极影响。校正最重要的预后因素后，无肌层时再次TUR对复发时间有临界显著影响[风险比（HR）0.67，P = 0.08]、进展（HR 0.46，P = 0.06）、CSS（HR 0.31，P = 0.07）和OS（HR 0.48，P = 0.05）。初次TUR标本中有肌层时再次TUR对任何终点结局均未改善。
我们的回顾性分析表明，对于T1-HG/G3患者，如果初次TUR标本中有肌层，可能无需再次TUR。
