Clinical significance of definite muscle layer in TUR specimen for evaluating progression rate in T1G3 bladder cancer: multicenter retrospective study by the Sapporo Medical University Urologic Oncology Consortium (SUOC)

Abstract

Patients without a muscle layer in the specimen had high risk for progression. The initial TUR must have a muscle layer in the specimen. Variations of progression rates in previous studies might be due to different proportions of patients who had a muscle layer in TUR specimens.

The impact of re‐transurethral resection on clinical outcomes in a large multicentre cohort of patients with T1 high‐grade/Grade 3 bladder cancer treated with bacille Calmette–Guérin

“…The risk of downstaging at second TUR was dramatically decreased when muscle was present in the primary TUR . Absence of muscle in the primary TUR specimen was also acknowledged as an independent predictor of progression to muscle‐invasive disease in a small retrospective series in patients with T1G3 bladder cancer . Tumour status at second TUR was found to be significantly associated with risk of recurrence, treatment failure and borderline significant for cancer‐specific death in a prospective, randomised study conducted by the Nordic Association of Urology of 250 patients with T1 bladder cancer randomised to BCG or epirubicin plus interferon‐α2b .…”

“…In a small retrospective cohort of patients with T1G3 NMIBC, long‐term outcomes were not improved by re‐TUR . The benefit of immediate re‐TUR may be different according to the presence or absence of detrusor muscle in the primary TUR specimen, the former being linked to a significant reduction of the risk of up‐staging and better prognosis . All these figures taken together suggest that the potential benefits of re‐TUR should be carefully weighed considering the healthcare burden of the procedure and its side‐effects .…”

Prospective Assessment of Vesical Imaging Reporting and Data System (VI-RADS) and Its Clinical Impact on the Management of High-risk Non–muscle-invasive Bladder Cancer Patients Candidate for Repeated Transurethral Resection

“…Notably, TURBT is operator dependent; therefore, presence of residual disease (reflecting incomplete BCa resection) varies widely with operators' experience, increasing recurrence rates, progression, and finally cancerrelated death [8,9]. About 7-30% of NMIBCs are understaged after TURBT, increasing up to 45% when resection does not include detrusor muscle [10,11]. Based on these issues, European Association of Urology guidelines recommend a second look and resection (repeated TURBT [Re-TURBT]) 2-6 wk following primary TURBT for all T1 tumors as well as for those in which no detrusor muscle in the specimen was included [12].…”

Prognostic Factors for Recurrence and Progression in Korean Non-Muscle-Invasive Bladder Cancer Patients: A Retrospective, Multi-Institutional Study

“… 7 18 In T1HG tumors, papillary tumor architecture (vs. sessile), no LVI, non-trigonal tumor location, intravesical BCG therapy, and presence of muscle layer in TURBT specimen were suggested as factors associated with improved PFS. 5 11 …”

“… 5 6 In addition, many studies have investigated the potential prognostic value of multiple factors, including sex, age, smoking, preoperative urine cytology result, tumor size, tumor morphology, tumor multiplicity, CIS, included muscle layer, lymphovascular invasion (LVI), restaging transurethral resection (TUR), and intravesical BCG therapy, in association with the recurrence and progression of NMIBC. 7 8 9 10 11 12 13 The prognostic value of several of these factors has been established, while such value remains controversial for others.…”