Levy Stephan, Péricart Sarah, Bajeot Anne Sophie, Fakhfakh Sami, Lesourd Marine, Soulié Michel, Pignot Géraldine, Roumiguié Mathieu
Department of Urology, CHU-Institut Universitaire du Cancer de Toulouse Oncopole, 1 Av Jean Poulhès, 31059, Toulouse, France.
Department of Pathology, CHU-Institut Universitaire du Cancer de Toulouse, Toulouse, France.
World J Urol. 2024 Aug 8;42(1):475. doi: 10.1007/s00345-024-05175-y.
A second look trans-urethral resection of the bladder (re-TUR) is recommended after the diagnosis of T1 high grade (T1HG) bladder cancer. Few studies have evaluated the results of re-TUR after a first en bloc resection (EBR) and none of them have specifically reported the pathological results on the field of previous T1 disease.
To report the rate of upstaging and the rate of residual disease (RD) on the field of T1HG lesions resected with EBR.
Between 01/2014 and 06/2022, patients from 2 centers who had a re-TUR after an EBR for T1HG urothelial carcinoma were retrospectively included. Primary endpoint was the rate of RD including the rate of upstaging to T2 disease on the scar of the primary resection. Secondary endpoints were the rate of any residual disease outside the field.
Seventy-five patients were included. No muscle invasive bladder cancer lesions were found after re-TUR. Among the 16 patients who had a RD, 4 were on the resection scar. All of these lesions were papillary and high grade. RD outside the field of the first EBR was observed in 12 patients.
After EBR of T1HG disease, none of our patients had an upstaging to MIBC. However, the rate of RD either on and outside the field of the EBR remains quite significant. We suggested that predictive factors of residual papillary disease (number of tumors at the initial TUR and concomitant CIS) might be suitable to select patient who will benefit of the re-TUR.
在诊断为T1高分级（T1HG）膀胱癌后，建议进行二次经尿道膀胱肿瘤切除术（re-TUR）。很少有研究评估首次整块切除（EBR）后re-TUR的结果，且无一专门报告先前T1疾病区域的病理结果。
报告EBR切除的T1HG病变区域的分期升级率和残留疾病（RD）率。
回顾性纳入2014年1月至2022年6月期间来自2个中心、因T1HG尿路上皮癌接受EBR后进行re-TUR的患者。主要终点是RD率，包括在初次切除瘢痕处分期升级为T2疾病的比率。次要终点是该区域外任何残留疾病的比率。
共纳入75例患者。re-TUR后未发现肌层浸润性膀胱癌病变。在16例有RD的患者中，4例位于切除瘢痕处。所有这些病变均为乳头状且高分级。在12例患者中观察到首次EBR区域外的RD。
T1HG疾病行EBR后，我们的患者均未分期升级为肌层浸润性膀胱癌（MIBC）。然而，EBR区域内和区域外的RD率仍然相当高。我们建议，残留乳头状疾病的预测因素（初次TUR时肿瘤数量和伴发的原位癌）可能适合用于选择将从re-TUR中获益的患者。
