Department of Clinical and Molecular Medicine, St. Olavs Hospital, Trondheim, Norway.
Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Scand J Urol. 2021 Aug;55(4):268-274. doi: 10.1080/21681805.2021.1917652. Epub 2021 May 17.
To evaluate the use of repeat transurethral resection of the bladder (reTURB) in stage T1 bladder cancer and its impact on treatment and survival in a Norwegian population-based cohort.
1130 patients registered at the Cancer Registry of Norway between 2008 and 2012 with primary urothelial T1 cancer were included. Information on surgical and medical procedures was provided by the Norwegian Patient Registry. Descriptive statistics were used to evaluate characteristics of patients receiving reTURB or not within 12 weeks from primary TURB (primTURB). Survival models identified risk factors and estimated cause-specific survival rates (CSS) adjusted for sex, age, WHO grade, concomitant cis and detrusor muscle at primTURB and treatment.
The 648 (57%) T1 patients with reTURB were significantly younger and had more WHO high grade tumors compared to those without reTURB. Of 275 patients without detrusor muscle at primTURB 114 (41%) had no reTURB. Of reTURB patients, 45 (7%) had muscle invasive tumor, 110 (17%) T1 and 378 (58%) Ta, cis or T0. Two-thirds of 81 patients receiving early cystectomy after reTURB had T1 or muscle invasive bladder cancer at reTURB. ReTURB did not impact adjusted CSS, but patients with T1 at reTURB had significantly lower CSS than those with < T1 conditions.
Almost half of the T1 patients did not undergo reTURB as recommended in guidelines. We show that reTURB makes the histology result more reliable with impact on both treatment and survival. Our results support the use of reTURB as recommended by EAU guidelines.
评估在挪威基于人群的队列中，T1 期膀胱癌患者重复经尿道膀胱肿瘤切除术（reTURB）的应用及其对治疗和生存的影响。
纳入了 2008 年至 2012 年在挪威癌症登记处登记的 1130 例原发性尿路上皮 T1 癌患者。手术和医疗程序的信息由挪威患者登记处提供。使用描述性统计数据评估了在 primTURB 后 12 周内接受或未接受 reTURB 的患者的特征。生存模型确定了风险因素，并估计了校正性别、年龄、世界卫生组织（WHO）分级、primTURB 时合并的顺铂和逼尿肌以及治疗因素后的特定原因生存（CSS）率。
648 例（57%）接受 reTURB 的 T1 患者明显更年轻，且 WHO 高级别肿瘤比例更高。在 275 例 primTURB 时无逼尿肌的患者中，114 例（41%）未接受 reTURB。reTURB 患者中，45 例（7%）有肌层浸润性肿瘤，110 例（17%）为 T1 期，378 例（58%）为 Ta、cis 或 T0。在 reTURB 后早期接受膀胱切除术的 81 例患者中，有 2/3 例在 reTURB 时患有 T1 或肌层浸润性膀胱癌。reTURB 并未影响调整后的 CSS，但在 reTURB 时患有 T1 期的患者的 CSS 明显低于患有＜T1 期条件的患者。
几乎一半的 T1 患者未按照指南建议进行 reTURB。我们表明，reTURB 可使组织学结果更可靠，从而影响治疗和生存。我们的结果支持按照欧洲泌尿外科学会（EAU）指南推荐使用 reTURB。
