Kamiya Naoto, Suzuki Hiroyoshi, Suyama Takahito, Kobayashi Masayuki, Fukasawa Satoshi, Sekita Nobuyuki, Mikami Kazuo, Nihei Naoki, Naya Yukio, Ichikawa Tomohiko
Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan.
Department of Urology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan.
Int J Clin Oncol. 2017 Apr;22(2):353-358. doi: 10.1007/s10147-016-1048-z. Epub 2016 Oct 15.
A retrospective, multi-institutional collaborative study was conducted to evaluate the impact of second transurethral resection (TUR) on the clinical outcome of non-muscle invasive high-grade bladder cancer and to identify predictors of invasion to the lamina propria (pT1) or deeper and residual tumor at the second TUR.
The clinical and pathological features of 198 patients with non-muscle invasive high-grade bladder cancer treated in five medical institutions from April 1990 to March 2013 were reviewed retrospectively. All patients underwent a second TUR within a mean of 1.5 months after the first resection. Clinicopathological findings of the first and second TURs were compared. Cancer-specific survival and recurrence-free survival were evaluated. Univariate and multivariate analyses for predictors of residual cancer at the second TUR were performed using a logistic regression model.
At the second TUR, no tumor was found in 111 (56 %) patients, and 87 (44 %) had residual cancer. At the first TUR, five pT1 patients (3 %) were upstaged to pT2, one pTa patient (1 %) was upstaged to pT1, and 12 G2 patients (6 %) had their tumor upgraded to G3. Patients the group with less than stage pT1 cancer at the second TUR had significantly better survival than those in the group with stage pT1 or deeper cancer. Tumor multiplicity at the first resection was an independent risk factor for pT1 or deeper tumor at the second TUR.
A second TUR is a valuable diagnostic procedure for accurate staging of non-muscle invasive high-grade bladder cancer. Tumor multiplicity at the first TUR was a significant independent predictor of pT1 or deeper tumor at the second TUR.
开展了一项回顾性、多机构合作研究，以评估二次经尿道膀胱肿瘤切除术（TUR）对非肌层浸润性高级别膀胱癌临床结局的影响，并确定二次TUR时侵犯固有层（pT1）或更深层以及残留肿瘤的预测因素。
回顾性分析了1990年4月至2013年3月在五家医疗机构接受治疗的198例非肌层浸润性高级别膀胱癌患者的临床和病理特征。所有患者在首次切除术后平均1.5个月内接受了二次TUR。比较了首次和二次TUR的临床病理结果。评估了癌症特异性生存率和无复发生存率。使用逻辑回归模型对二次TUR时残留癌的预测因素进行单因素和多因素分析。
二次TUR时，111例（56%）患者未发现肿瘤，87例（44%）有残留癌。首次TUR时，5例pT1患者（3%）分期上调至pT2，1例pTa患者（1%）分期上调至pT1，12例G2患者（6%）肿瘤分级升级为G3。二次TUR时癌症分期低于pT1的患者生存率明显高于pT1或更深分期癌症的患者。首次切除时肿瘤多发是二次TUR时pT1或更深层肿瘤的独立危险因素。
二次TUR是准确分期非肌层浸润性高级别膀胱癌的有价值的诊断方法。首次TUR时肿瘤多发是二次TUR时pT1或更深层肿瘤的重要独立预测因素。
