Academic Urology Unit, University of Sheffield, Sheffield, UK.
Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland.
Eur Urol. 2018 Jun;73(6):925-933. doi: 10.1016/j.eururo.2018.02.014. Epub 2018 Mar 6.
Initial treatment for most bladder cancers (BCs) involves transurethral resection (TUR) or tumours. Often more cancer is found after the initial treatment in around half of patients, requiring a second resection. Repeat transurethral resection (reTUR) is recommended for high-risk, non-muscle-invasive bladder cancer (NMIBC) to remove any residual disease and improve cancer outcomes.
To systematically review the practice and therapeutic benefit of an early reTUR for high-risk NMIBC.
A systematic review of original articles was performed using PubMed/Medline and Web of Science databases in December 2016 (initial) and October 2017 (final). We searched the references of included papers.
We screened 15 209 manuscripts and selected 31 detailing 8409 persons with high-grade Ta and T1BC for inclusion. Detrusor muscle was found at initial TUR histology in 30-100% of cases. Residual tumour at reTUR was found in 17-67% of patients following Ta and in 20-71% following T1 cancer. Most residual tumours (36-86%) were found at the original resection site. Upstaging occurred in 0-8% (Ta to ≥T1) and 0-32% (T1 to ≥T2) of cases. Conflicting data report the impact of reTUR on subsequent recurrence and cancer-specific mortality. Recurrence for Ta was 16% in the reTUR group versus 58% in the non-reTUR group. For T1, recurrence ranged from 18% to 56%, but no clear trend was identified between reTUR and control. No clear relationship between reTUR and progression was found for Ta, although for T1 rates were higher in the non-reTUR group in series with control populations (5/6 studies). Overall mortality was slightly reduced in the reTUR group in two studies with controls (22-30% vs 26-36% [no reTUR]).
Residual tumour is common after TUR for high-risk NMIBC. The reTUR helps in the diagnosis of this residual cancer and may improve outcomes for cancers initially staged as T1.
Some bladder cancers (BCs) are aggressive but confined to the bladder surface. Initial treatment includes endoscopic resection. More cancer is found after the initial treatment in approximately half of patients. In the aggressive but confined group of BC, a second resection, a few weeks after the first, may help find this residual cancer and improve outcomes, although the evidence quality for this is weak.
大多数膀胱癌（BC）的初始治疗包括经尿道膀胱肿瘤切除术（TUR）或肿瘤切除术。大约一半的患者在初始治疗后常常发现更多的癌症，需要进行第二次切除。为了清除任何残留疾病并改善癌症预后，建议对高危、非肌肉浸润性膀胱癌（NMIBC）进行重复经尿道膀胱肿瘤切除术（reTUR）。
系统评价高危 NMIBC 早期 reTUR 的治疗效果。
2016 年 12 月（初始）和 2017 年 10 月（最终），我们使用 PubMed/Medline 和 Web of Science 数据库对原始文章进行了系统评价。我们检索了纳入文献的参考文献。
我们筛选了 15209 篇手稿，选择了 31 篇详细描述了 8409 例高级 Ta 和 T1BC 患者的论文进行纳入分析。在初始 TUR 组织学中，逼尿肌在 30%-100%的病例中被发现。在 Ta 患者中，有 17%-67%的患者在 reTUR 时发现残留肿瘤，在 T1 癌症患者中，有 20%-71%的患者发现残留肿瘤。大多数残留肿瘤（36%-86%）位于原切除部位。在 0%-8%（Ta 升级为≥T1）和 0%-32%（T1 升级为≥T2）的病例中发生了分期升级。关于 reTUR 对随后复发和癌症特异性死亡率的影响，有相互矛盾的数据报道。在 reTUR 组中，Ta 的复发率为 16%，而非 reTUR 组为 58%。对于 T1，复发率在 18%-56%之间，但在 reTUR 组和对照组之间没有明确的趋势。在 Ta 患者中，reTUR 与进展之间没有明显的关系，尽管在有对照组的系列中，T1 患者的比率在非 reTUR 组中更高（5/6 项研究）。在两项有对照组的研究中，reTUR 组的总死亡率略有降低（22%-30%比 26%-36%[无 reTUR]）。
高危 NMIBC 患者 TUR 后常有残留肿瘤。reTUR 有助于诊断残留的癌症，并可能改善最初分期为 T1 的癌症的预后。
一些膀胱癌（BC）具有侵袭性，但局限于膀胱表面。初始治疗包括内镜下切除术。大约一半的患者在初始治疗后会发现更多的癌症。在侵袭性但局限于膀胱表面的 BC 患者中，在第一次手术后几周内进行第二次切除（reTUR），可能有助于发现这些残留的癌症并改善预后，尽管这方面的证据质量较弱。
