The clinical significance of a second transurethral resection for T1 high-grade bladder cancer: Results of a prospective study.
10.4111/kju.2015.56.6.429
- Author:
Ji Sung SHIM
1
;
Hoon CHOI
;
Tae Il NOH
;
Jong Hyun TAE
;
Sung Goo YOON
;
Seok Ho KANG
;
Jae Hyun BAE
;
Hong Seok PARK
;
Jae Young PARK
Author Information
1. Department of Urology, Korea University Ansan Hospital, Ansan, Korea. jaeyoungpark@korea.ac.kr
- Publication Type:Original Article ; Evaluation Studies ; Research Support, Non-U.S. Gov't
- Keywords:
Neoplasm invasiveness;
Recurrence;
Urinary bladder neoplasms
- MeSH:
Aged;
Aged, 80 and over;
Cystectomy/methods;
Female;
Humans;
Kaplan-Meier Estimate;
Male;
Middle Aged;
Neoplasm Grading;
Neoplasm Invasiveness;
Neoplasm Staging;
Neoplasm, Residual;
Prognosis;
Prospective Studies;
Reoperation/methods;
Treatment Outcome;
Urinary Bladder Neoplasms/pathology/*surgery
- From:Korean Journal of Urology
2015;56(6):429-434
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: This study was designed to estimate the value of a second transurethral resection of bladder tumor (TURBT) procedure in patients with initially diagnosed T1 high-grade bladder cancer. MATERIALS AND METHODS: Between August 2009 and January 2013, a total of 29 patients with T1 high-grade bladder cancer prospectively underwent a second TURBT procedure. Evaluation included the presence of previously undetected residual tumor, changes to histopathological staging or grading, and tumor location. Recurrence-free and progression-free survival curves were generated to compare the prognosis between the groups with and without residual lesions by use of the Kaplan-Meier method. RESULTS: Of 29 patients, 22 patients (75.9%) had residual disease after the second TURBT. Staging was as follows: no tumor, 7 (24.1%); Ta, 5 (17.2%); T1, 6 (20.7%); Tis, 6 (20.7%); Ta+Tis, 1 (3.4%); T1+Tis, 1 (3.4%); and > or =T2, 3 (10.3%). The muscle layer was included in the surgical specimen after the initial TURBT in 24 patients (82.7%). In three patients whose cancer was upstaged to pT2 after the second TURBT, the initial surgical specimen contained the muscle layer. In the group with residual lesions, the 3-year recurrence-free survival and 3-year progression-free survival rates were 50% and 66.9%, respectively, whereas these rates were 68.6% and 68.6%, respectively, in the group without residual lesions. This difference was not statistically significant. CONCLUSIONS: Initial TURBT does not seem to be enough to control T1 high-grade bladder cancer. Therefore, a routine second TURBT procedure should be recommended in patients with T1 high-grade bladder cancer to accomplish adequate tumor resection and to identify patients who may need to undergo prompt cystectomy.
