Chang Dwayne T S, Picardo Alarick
St. John of God Murdoch Hospital, Murdoch, WA 6150, Australia.
Fiona Stanley Hospital, Murdoch, WA 6150, Australia.
Bladder (San Franc). 2020 Apr 2;7(2):e42. doi: 10.14440/bladder.2020.814. eCollection 2020.
To determine the rate of residual disease and under-staging after primary transurethral resection (TUR) of bladder tumors (TURBT) in tertiary hospitals in Western Australia.
A retrospective study was performed evaluating all patients with TaHG (stage Ta, high-grade), T1LG (stage T1, low-grade) or T1HG (stage T1, high-grade) bladder cancer on primary TURBT conducted between January 1, 2012 and December 31, 2017 at the four largest metropolitan public hospitals in Western Australia. Only patients who underwent repeat resection within 3 months from initial resection were included. Those with previous history of bladder cancer, incomplete follow-up data and visibly incomplete initial resection were excluded. Baseline patient demographics, macroscopic clearance at initial resection, and disease data at initial and repeat resections were recorded.
Sixty-seven patients with a median age of 71 years were included in this study. At initial resection, T1HG was the most common disease stage (64.2%) and detrusor muscle was present in 82.1% of initial resections. At repeat resection, 41.8% of cases had residual disease. The rate of upstaging to muscle-invasive bladder cancer was 3.0%. Patients treated by operators with five or less years of formal training did not have a significantly different rate of residual disease from patients treated by operators with more than five years of experience.
Repeat TUR should remain an essential practice due to high rates of residual disease and a small risk of tumor under-staging. The presence of detrusor muscle and macroscopic clearance should not be used as surrogates for adequacy of resection or consideration of avoiding a repeat TUR, even for TaHG disease.
确定西澳大利亚州三级医院原发性膀胱肿瘤经尿道膀胱肿瘤切除术（TURBT）后残留疾病和分期不足的发生率。
进行一项回顾性研究，评估2012年1月1日至2017年12月31日期间在西澳大利亚州四家最大的都市公立医院接受原发性TURBT的所有TaHG（Ta期，高级别）、T1LG（T1期，低级别）或T1HG（T1期，高级别）膀胱癌患者。仅纳入在初次切除后3个月内接受再次切除的患者。排除有膀胱癌既往史、随访数据不完整以及初次切除明显不完整的患者。记录患者的基线人口统计学数据、初次切除时的宏观切缘情况以及初次和再次切除时的疾病数据。
本研究纳入了67例中位年龄为71岁的患者。初次切除时，T1HG是最常见的疾病分期（64.2%），82.1%的初次切除标本中有逼尿肌。再次切除时，41.8%的病例存在残留疾病。分期升级为肌层浸润性膀胱癌的发生率为3.0%。接受正规培训五年及以下的术者治疗的患者与经验超过五年的术者治疗的患者，其残留疾病发生率无显著差异。
由于残留疾病发生率高且肿瘤分期不足风险小，再次TUR仍应作为一项基本操作。即使对于TaHG疾病，逼尿肌的存在和宏观切缘情况也不应作为切除充分性的替代指标或用于考虑避免再次TUR。
