Özsoy Çağatay, Demir Yiğit, Yılmaz Kayhan, Ölçücü Mahmut Taha, Kılıç Şahin, Ateş Mutlu
Adnan Menderes University Medical Faculty, Department of Urology, Aydın, Turkey.
Antalya Training and Research Hospital, Department of Urology, Antalya, Turkey.
Fr J Urol. 2024 Sep;34(9):102705. doi: 10.1016/j.fjurol.2024.102705. Epub 2024 Jul 24.
Non-muscle invasive bladder cancers (NMIBC) constitute approximately 75% of bladder cancer cases. Primary transurethral resection (TUR) plays a pivotal role in both diagnosis and treatment. However, despite initial resection, tumors are often missed, leaving behind microscopic residual tumors. This study aims to prospectively investigate the surgical margins of tumors, which may serve as a potential source of residual tumors.
Seventy patients diagnosed with NMIBC who underwent primary TUR were enrolled in this study. Following initial resection, samples were collected from the normal-appearing mucosa extending 1cm beyond the surgical margins. Lesions were categorized as 'healthy margins' for benign lesions, 'tumoral margins' for urothelial cancer, and 'dysplastic margins' for urothelial dysplasia. Clinical and pathological features of these groups were compared, and risk factors for detecting transitional cell carcinoma (TCC) in the normal-looking mucosa were analyzed.
The tumoral margins group showed a significantly higher rate of T1 stage tumors compared to the healthy margins group, and a significantly higher rate of high-grade (HG) tumors compared to the dysplastic margins group. Moreover, the tumoral margins group had a significantly higher proportion of high-risk patients (85.7%) compared to the other groups, while the healthy margins group had a significantly higher proportion of low-risk patients (35.3%) compared to the tumoral margins group (0.0%). Additionally, the tumoral margins group demonstrated a significantly higher rate of carcinoma in situ (CIS) compared to the healthy margins group (35.7% vs. 5.9%). Detection of urothelial cancer at the margins was associated with T1 stage, HG stage, and the presence of CIS based on univariate analyses.
To minimize residual tumors and prevent recurrence in patients undergoing primary TUR, we advocate for the resection of macroscopically visible tumors with nearly 2cm of intact bladder tissue, thereby enhancing the quality of TUR.
This study provides Level II evidence, based on its design as a prospective observational study. The findings are derived from well-designed cohort analyses, providing significant associations and insights into the factors affecting surgical margins in NMIBC patients.
非肌层浸润性膀胱癌（NMIBC）约占膀胱癌病例的75%。初次经尿道切除术（TUR）在诊断和治疗中都起着关键作用。然而，尽管进行了初次切除，肿瘤仍常被遗漏，留下微小残留肿瘤。本研究旨在前瞻性地研究肿瘤的手术切缘，其可能是残留肿瘤的潜在来源。
本研究纳入了70例诊断为NMIBC并接受初次TUR的患者。初次切除后，从手术切缘外1cm处外观正常的黏膜采集样本。病变分为良性病变的“健康切缘”、尿路上皮癌的“肿瘤切缘”和尿路上皮发育异常的“发育异常切缘”。比较这些组的临床和病理特征，并分析在外观正常的黏膜中检测到移行细胞癌（TCC）的危险因素。
与健康切缘组相比，肿瘤切缘组T1期肿瘤的发生率显著更高；与发育异常切缘组相比，高级别（HG）肿瘤的发生率显著更高。此外，与其他组相比，肿瘤切缘组高危患者的比例显著更高（85.7%），而与肿瘤切缘组（0.0%）相比，健康切缘组低危患者的比例显著更高（35.3%）。另外，与健康切缘组相比，肿瘤切缘组原位癌（CIS）的发生率显著更高（35.7%对5.9%）。基于单因素分析，切缘处尿路上皮癌的检测与T1期、HG期以及CIS的存在相关。
为了使接受初次TUR的患者残留肿瘤最小化并预防复发，我们提倡切除肉眼可见肿瘤并保留近2cm完整膀胱组织，从而提高TUR的质量。
本研究基于其作为前瞻性观察性研究的设计提供二级证据。研究结果来自精心设计的队列分析，为影响NMIBC患者手术切缘的因素提供了显著关联和见解。
