Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
J Urol. 2021 Aug;206(2):252-259. doi: 10.1097/JU.0000000000001735. Epub 2021 Mar 29.
The primary advantage of en bloc resection of bladder tumors is to provide better diagnostic accuracy. However, the clinical significance of horizontal and vertical margin has not been demonstrated. We evaluated the clinical importance of surgical margins in patients who underwent en bloc resection of bladder tumors.
We retrospectively analyzed the records of 140 consecutive patients who underwent en bloc resection of bladder tumors for nonmuscle invasive bladder cancer. We analyzed perioperative and oncological outcome, and compared patient demographics and recurrence-free survival for horizontal findings. The relationship between surgical margin and second transurethral resection outcome in pT1 bladder cancer was also analyzed.
Mean tumor diameter was 17.2±9.8 mm. Pathological stages were 93 cases in pTa and 47 cases in pT1. Diagnostic rates for the horizontal and vertical margins were 63% and 99%, respectively. The rates of sessile, carcinoma in situ, high grade, and pT1 tumors were significantly higher in the horizontal margin positive group (41) than in the negative group (47). There was no significant difference in 2-year recurrence-free survival based on horizontal margin findings (negative: 72.4%, positive: 75.4%, p=0.87). A second transurethral resection was performed in 31 of the 47 pT1 patients; pT1 residue was seen only in vertical margin positive cases, and 5 pTa/pTis residues at the transurethral resection scar were seen in 15 horizontal margin positive patients.
Horizontal margin positive findings were not associated with recurrence-free survival, but careful assessment is warranted regarding residue at the original site. A second transurethral resection should be considered in patients with horizontal and vertical margin positive pT1 bladder cancer.
整块切除膀胱肿瘤的主要优势在于提供更好的诊断准确性。然而，水平和垂直切缘的临床意义尚未得到证实。我们评估了整块切除膀胱肿瘤的患者中手术切缘的临床重要性。
我们回顾性分析了 140 例连续接受整块膀胱肿瘤切除术治疗非肌层浸润性膀胱癌患者的记录。我们分析了围手术期和肿瘤学结果，并比较了水平切缘的患者人口统计学和无复发生存率。还分析了 pT1 膀胱癌中手术切缘与二次经尿道电切术结果的关系。
平均肿瘤直径为 17.2±9.8mm。病理分期为 93 例 pTa 和 47 例 pT1。水平和垂直切缘的诊断率分别为 63%和 99%。水平切缘阳性组（41 例）的固有型、高级别和 pT1 肿瘤的发生率明显高于阴性组（47 例）（41）。根据水平切缘结果，2 年无复发生存率无显著差异（阴性：72.4%，阳性：75.4%，p=0.87）。47 例 pT1 患者中有 31 例接受了二次经尿道电切术；仅在垂直切缘阳性病例中可见 pT1 残留，在 15 例水平切缘阳性患者中有 5 例可见经尿道电切术瘢痕处的 pTa/pTis 残留。
水平切缘阳性结果与无复发生存率无关，但应仔细评估原位残留情况。对于水平和垂直切缘阳性的 pT1 膀胱癌患者，应考虑二次经尿道电切术。
