Nakamura Yuki, Yoshida Soichiro, Arita Yuki, Takeshita Ryo, Kimura Koichiro, Kobayashi Masaki, Fujiwara Motohiro, Ishikawa Yudai, Fukuda Shohei, Waseda Yuma, Tanaka Hajime, Jinzaki Masahiro, Fujii Yasuhisa
Department of Urology, Institute of Science Tokyo, Tokyo, Japan.
Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
Int J Urol. 2025 Mar;32(3):264-269. doi: 10.1111/iju.15638. Epub 2024 Dec 9.
The efficacy of Vesical Imaging-Reporting and Data System (VI-RADS) for the second transurethral resection (TUR) has not been adequately validated. This study aimed to evaluate the utility of the VI-RADS for high-risk patients with non-muscle-invasive bladder cancer (NMIBC) who are candidates for a second TUR.
We retrospectively analyzed 116 patients who received magnetic resonance imaging (MRI) prior to an initial TUR and underwent a second TUR for a diagnosis of high-risk NMIBC at the initial TUR. MRI images were retrospectively classified according to VI-RADS. Second TUR outcomes and recurrence-free and progression-free survival rates were compared with VI-RADS scores.
Ninety-nine (91%) patients were diagnosed with T1 bladder cancer at the initial TUR. At the second TUR, residual cancer was found in 53 (49%) cases, including five (4.6%) cases of muscle invasion. With a median follow-up of 41 months, the 2-year bladder recurrence-free survival rate was 71% and the 2-year progression-free rate was 85%. By two radiologists' consensus, 30 (28%)/49 (45%)/16 (15%)/10 (9.2%)/4 (3.7%) cases were classified as VI-RADS 1/2/3/4/5, respectively. Of five pT2 upstage cases, three were VI-RADS 1, one was VI-RADS 2, and one was VI-RADS 3. There was no significant association between VI-RADS and cancer residual rate and pT2 upstage rate in second TUR outcomes, and recurrence-free and progression-free survival rates.
In high-risk NMIBCs, a certain number of residual cancers and pT2 upstage cases exist after the initial TUR, and a second TUR should be performed regardless of VI-RADS scores.
膀胱影像报告和数据系统（VI-RADS）对二次经尿道膀胱肿瘤切除术（TUR）的疗效尚未得到充分验证。本研究旨在评估VI-RADS对有二次TUR指征的高危非肌层浸润性膀胱癌（NMIBC）患者的应用价值。
我们回顾性分析了116例在初次TUR前接受磁共振成像（MRI）检查，并因初次TUR诊断为高危NMIBC而接受二次TUR的患者。MRI图像根据VI-RADS进行回顾性分类。将二次TUR结果、无复发生存率和无进展生存率与VI-RADS评分进行比较。
99例（91%）患者在初次TUR时被诊断为T1期膀胱癌。在二次TUR时，53例（49%）发现残留癌，其中5例（4.6%）为肌层浸润。中位随访41个月，2年无膀胱复发生存率为71%，2年无进展率为85%。经两位放射科医生一致认定，分别有30例（28%）/49例（45%）/16例（15%）/10例（9.2%）/4例（3.7%）被分类为VI-RADS 1/2/3/4/5。在5例pT2期进展期病例中，3例为VI-RADS 1，1例为VI-RADS 2，1例为VI-RADS 3。VI-RADS与二次TUR结果中的癌残留率和pT2期进展期率以及无复发生存率和无进展生存率之间无显著相关性。
在高危NMIBC中，初次TUR后存在一定数量的残留癌和pT2期进展期病例，无论VI-RADS评分如何，均应进行二次TUR。
