RT/RCT after TURBT with selective bladder preservation is a reasonable alternative to intravesical treatment or early cystectomy for high-risk T1 bladder cancer.
Study Type – Therapy (case series)
Level of Evidence 4
What's known on the subject? and What does the study add?
Transurethral resection of bladder tumour (TURBT) is the ‘gold standard’ in the diagnosis and therapy of non‐muscle‐invasive bladder cancer. To improve the quality of this technique an additional TUR (after 4–6 weeks) or a simultaneous photodynamic diagnosis is often offered.
The present study shows different variables that influence, to a greater or lesser extent, the accuracy of the TUR diagnosis and the success of the operation. This is very important for the further management of bladder cancer, be it in tumour follow‐up or in preparation for more invasive therapies.
OBJECTIVE
To analyse the impact of a standardised extended transurethral resection of bladder tumour (TURBT) protocol on the determination of the residual tumour status at initial TURBT session and recurrence rate in the primary resection area. Despite, the fact that there is a clear consensus on the aims of TURBT, there is little agreement on how to perform TURBT to achieve that goal.
PATIENTS AND METHODS
We retrospectively evaluated 221 consecutive patients, who underwent 305 TURBT sessions for bladder cancer, including patients with recurrent tumours.
All the TURBTs were extended by taking additional deep and marginal specimens, according to a standardised protocol.
Clinical and histopathological data were retrieved from the patients' records.
RESULTS
Across all tumour stages, residual tumour (pR1) was found in 38% of the additionally taken specimens.
There was a significant association of pR1 status with tumour stage, grade, and size.
Also in the group of non‐muscle‐invading tumours, the rate of R1 resection was rather high at 22%.
There was no association with focality and the training status of the surgeon.
At follow‐up, of all the patients with a unifocal primary tumour there was recurrence in the same area as the primary in 5.1%.
CONCLUSIONS
Extended TURBT provides detailed information about the horizontal and vertical extent of the bladder tumour.
The implementation of standardised TURBT procedures, such as our protocol of an extended TURBT, is greatly needed to improve local tumour control.
Whether a diagnostic re‐TUR may be restricted to those cases with positive margins or ground specimens remains to be studied.
The standard treatment for invasive bladder cancer is radical cystectomy. In selected patients, bladder‐sparing therapy can be performed by transurethral resection (TURBT) and radio‐chemotherapy (RCT) or radiotherapy (RT). Our published in vitro data suggest that the Neuropilin‐2 (NRP2)/VEGF‐C axis plays a role in therapy resistance. Therefore, we studied the prognostic impact of NRP2 and VEGF‐C in 247 bladder cancer patients (cN0M0) treated with TURBT and RCT (n = 198) or RT (n = 49) and a follow‐up time up to 15 years. A tissue microarray was analyzed by immunohistochemistry. NRP2 expression emerged as a prognostic factor in overall survival (OS; HR: 3.42; 95% CI: 1.48 – 7.86; p = 0.004) and was associated with a 3.85‐fold increased risk of an early cancer specific death (95% CI: 0.91 – 16.24; p = 0.066) in multivariate analyses. Cancer specific survival (CSS) dropped from 166 months to 85 months when NRP2 was highly expressed (p = 0.037). Patients with high VEGF‐C expression have a 2.29‐fold increased risk of shorter CSS (95% CI: 1.03–5.35; p = 0.043) in univariate analysis. CSS dropped from 170 months to 88 months in the case of high VEGF‐C expression (p = 0.041). Additionally, NRP2 and VEGF‐C coexpression is a prognostic marker for OS in multivariate models (HR: 7.54; 95% CI: 1.57–36.23; p = 0.012). Stratification for muscle invasiveness (T1 vs. T2‐T4) confirmed the prognostic role of NRP2 and NRP2/VEGF‐C co‐expression in patients with T2‐T4 but also with high risk T1 disease. In conclusion, immunohistochemistry for NRP2 and VEGF‐C has been determined to predict therapy outcome in bladder cancer patients prior to TURBT and RCT.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.