Mehr Justin P, Bates Jenna N, Lerner Seth P
Scott Department of Urology, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA.
Bladder Cancer. 2023 Mar 31;9(1):41-48. doi: 10.3233/BLC-220066. eCollection 2023.
One of the best predictors of positive outcomes in bladder cancer (BC) is pT0 following radical cystectomy (RC). Discordance between clinical and pathologic staging affects decision-making in patients with clinical absence of disease (cT0).
We sought to determine whether a restaging transurethral resection of bladder tumor (re-TURBT) improves clinical staging accuracy relative to pathologic stage RC in patients treated with neoadjuvant chemotherapy (NAC) versus those who did not receive NAC.
We queried our prospectively maintained IRB approved institutional database to identify 129 patients who underwent RC from 2013 to 2019 with a re-TURBT prior to RC. 53 patients were treated with NAC between their initial and re-TURBT and 76 patients were not treated with NAC.
The overall upstaging rate from re-TURBT to RC was 34.9%. There was no significant difference in the upstaging rate between the NAC and no-NAC groups - 31.0% vs. 37.0%, respectively. In patients who were cT0 on re-TURBT, the NAC group did not show a significantly greater rate of pathologic clinical CR (pT0) than the no NAC group - 38.5% vs. 37.5%, respectively. Re-TURBT with staging < rT2 as a predictor for absence of MIBC on pathologic staging (<ypT2) did not show a significant difference between the NAC and no NAC group, with a negative predictive value (NPV) of 69.0% and 66.7%, respectively.
Re-TURBT after NAC does not show statistically significant improvement in staging accuracy relative to pathologic stage at RC compared to re-TURBT in patients not treated with NAC.
膀胱癌（BC）预后良好的最佳预测指标之一是根治性膀胱切除术（RC）后的pT0。临床分期与病理分期之间的不一致会影响临床无疾病（cT0）患者的决策。
我们试图确定，相较于病理分期的RC，重新分期经尿道膀胱肿瘤切除术（re-TURBT）能否提高接受新辅助化疗（NAC）患者与未接受NAC患者的临床分期准确性。
我们查询了前瞻性维护的、经机构审查委员会（IRB）批准的机构数据库，以确定2013年至2019年间接受RC且在RC前进行re-TURBT的129例患者。53例患者在初次手术和re-TURBT之间接受了NAC，76例患者未接受NAC。
从re-TURBT到RC的总体分期上调率为34.9%。NAC组和非NAC组的分期上调率无显著差异，分别为31.0%和37.0%。在re-TURBT时为cT0的患者中，NAC组的病理临床完全缓解（pT0）率并不显著高于非NAC组，分别为38.5%和37.5%。以分期＜rT2的re-TURBT作为病理分期时无肌层浸润性膀胱癌（＜ypT2）的预测指标，NAC组和非NAC组之间无显著差异，阴性预测值（NPV）分别为69.0%和66.7%。
与未接受NAC的患者相比，NAC后的re-TURBT在分期准确性方面相对于RC时的病理分期并未显示出统计学上的显著改善。
