Effect of Routine Repeat Transurethral Resection for Superficial Bladder Cancer: A Long-term Observational Study

Grimm, Marc-Oliver; Steinhoff, Christine; Simon, Xenia; Spiegelhalder, Philipp; Ackermann, R.; Vögeli, Thomas-Alexander

doi:10.1097/01.ju.0000070437.14275.e0

Cited by 268 publications

(176 citation statements)

References 17 publications

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“…Patients who had a history of a previous TUR, high-grade tumor and intravesical therapy were excluded from the study in order to establish a homogeneous group of patients and to avoid the effect of intravesical treatment on recurrence. In univariate and multivariate analyses, in accordance with the literature, the presence of tumor multiplicity and MP presence were determined as the factors predicting recurrence (6,11,12,15,20,21). Recurrence has been shown to be statistically significantly more frequent in patients with non-MP ( Table 2).…”

Section: Mariappan Et Al (6) Have Demonstrated That (I) Multiplicitysupporting

confidence: 54%

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Influence of the Presence of Muscularis Propria on Recurrence and the Quality of Transurethral Resection in Low-Grade, Stage pTa Bladder Tumors

Türk¹,

Ün²,

Tarhan³

et al. 2016

jus

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ÖZ AmaçYeni kasa invaze olmayan mesane tümörlerinin standart tedavisi mesanenin transüretral rezeksiyonu (TURM) ve intravezikal kemoterapidir. Yetersiz tümör rezeksiyonu, erken nüks ve düşük evreleme gibi hastalığın seyrini değiştirecek durumları ortaya çıkarmaktadır. Bu nedenle kasa invaze olmayan mesane tümörlerinin tedavisinde kaliteli TURM önemli bir faktördür. gereç ve yöntemPrimer mesane tümörü nedeniyle TURM olmuş 841 hasta çalışmaya alındı. Toplam 597 hasta bu kriterlerimize uymadığı için çalışmadan çıkarıldı. Grup 1'de patoloji spesmeninde müskülaris propria (MP) görülen hastalar bulunurken; grup 2, TURM örneğinde MP görülmeyen hastalardan oluşmuştur. Hastalar; cinsiyet, tümör sayısı, patoloji spesmenindeki tümör hacmi, MP durumu, nüks durumu, nüks zamanı ve progresyon açısından değerlendirildi. BulgularNüks eden 92 hastanın sadece 14'ünde (%15,2) MP bulunurken geriye kalan 78 (%84,8) hasta da MP görülmemiştir (p=0,004). Grup 1'de progrese olan hasta 4 (%14,2), grup 2'de 28 (%29) hasta olarak ortaya çıkmıştır (p=0,159). Tek değişkenli analizde, tümör multiplitesi (p=0,003) ve MP yokluğu (p=0,004) rekürrens üzerine etkili bulunmuştur. Çok değişkenli analizde yine bu iki parametre nüks üzerine etkili bulunmuştur (p=0,004). objectiveTransurethral resection (TUR) of the bladder and intravesical chemotherapy is the standard treatment option for non-muscle-invasive bladder tumors. Inadequate tumor resection results in early recurrence and staging inaccuracies, which all will change the course of the disease. High-quality TUR treatment is therefore an important factor in the treatment of non-muscle-invasive bladder tumors. In this study, we investigated the significance of detecting the presence of muscularis propria (MP) in pathology specimens of low-grade, stage pTa tumors in patients who were treated with TUR due to primary bladder tumors, with regard to recurrence, time to recurrence and progression. Materials and MethodsInitially, 841 patients who were treated with TUR due to primary bladder tumors were enrolled in the study. A total of 597 patients were excluded from the study because they failed to meet the study criteria. Group 1 consisted of patients with MP detected in the pathology specimens; whereas group 2 consisted of patients whose TUR specimens did not include MP. The patients were evaluated with regard to gender, tumor number, presence or absence of MP, and recurrence status. ResultsMP was observed in only 14 (15.2%) of 92 patients with recurrence, but not in the remaining 78 (84.8%) (p=0.004). Progression occurred in 4It was pointed out that muscularis propria presence in the pathology specimens of low-grade stage pTa tumours is an indicator of a high quality transurethral resection.

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Section: Mariappan Et Al (6) Have Demonstrated That (I) Multiplicitysupporting

confidence: 54%

“…High residual tumor rate and tumor upstaging rates of 40-51% were observed in non-MP stage pT1 patients (14,15,16,17). The absence of MP has been shown to be associated with increased risk of early recurrence, even in low-grade pTa tumors (6).…”

Section: Mariappan Et Al (6) Have Demonstrated That (I) Multiplicitymentioning

confidence: 99%

Influence of the Presence of Muscularis Propria on Recurrence and the Quality of Transurethral Resection in Low-Grade, Stage pTa Bladder Tumors

Türk¹,

Ün²,

Tarhan³

et al. 2016

jus

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“…The authors mentioned the reduced activity of immune system by age as the cause of poorer survival rates and higher risk of progression (6). In that study, the authors did not mention any information on performing a second TUR in their population, a factor which is associated with decreased recurrence and progression rates as well as better response to BCG (13,14). In our study, all patients similarly received maintenance BCG, besides, all patients underwent a second TUR.…”

Section: Discussionmentioning

confidence: 85%

Effect of Age on Outcome of High-Risk Non-Muscle-Invasive Bladder Cancer Patients Treated with Second Transurethral Resection and Maintenance Bacillus Calmette-Guerin Therapy

Baltacı¹,

Bozlu²,

Yıldırım³

et al. 2016

jus

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What's known on the subject? and What does the study add? ÖZ ABSTRACT AmaçBu çalışmada yüksek riskli kasa invaze olmayan mesane kanseri (KİOMK) nedeniyle ikinci transüretral rezeksiyon (TUR) yapılan ve idame Bacillus Calmette-Guerin (BCG) tedavisi alan hastalarda nüks ve progresyon oranlarına yaşın etkisinin değerlendirilmesi amaçlandı. gereç ve yöntemBu çok merkezli çalışmada 2005-2012 yılları arasında yüksek riskli KİOMK nedeniyle tedavi edilen hastaların verileri incelendi. İkinci TUR da kasa invaziv olmayan, indüksiyon sonrası en az 1 yıl süre ile idame BCG tedavisi alan ve en az 12 ay tedavi alan hastalar dahil edildi. Yaşın etkisi hem iki grup olarak (<70 vs ≥70 yaş) hem de on yıllık artan gruplarda incelendi. Ki-kare, Student T-test ve ANOVA testi grupların karşılaştırılması için objective To determine the effect of age on recurrence and progression rates in a population of high-risk non-muscle invasive bladder cancer (NMIBC) patients treated with a second transurethral resection (TUR) and at least 1 year of maintenance Bacillus Calmette-Guerin (BCG) therapy. Materials and MethodsIn this multicenter study, we reviewed the data of patients treated for high-risk NMIBC between 2005 and 2012. Patients without a muscleinvasive cancer on second TUR and received induction BCG and at least one year of maintenance BCG therapy and at least 12 months of follow-up after completion of maintenance BCG were included. Effect of age was analyzed both dichotomously (<70 or ≥70 years) as well as High risk non-muscle invasive bladder cancer patients should be treated with maintenance Bacillus Calmette-Guerin (BCG) to obtain a reduce the risk of progression. The exact mechanism of action of BCG has not been clearly understood. However, there is clearly an action of immune system. Capacity of immune system decreases with advanced age and age has been shown to be associated with increased progression rates and decreased survival rates in patients receiving BCG. Previous studies are heterogeneous with respect to their population and they did not evaluate the effect of age on maintenance BCG response with the definition of progression involving Ta upstaging to T1.

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“…28 After 5 years of follow-up in 124 patients, Grimm and colleagues found that 63% of those who underwent a repeat TURBT had tumour-free bladders compared with 40% of those who did not. 29 Similarly, a recent study demonstrated that a restaging TUR improved initial response to intravesical immunotherapy. 24 We recommend that a second TUR should always be performed 4 to 6 weeks after the initial resection when the initial TUR is incomplete or a T1 tumour is detected in the absence of muscularis propria in the specimen (Grade A recommendation).…”

Section: Second Turbtmentioning

confidence: 99%

Canadian guidelines for treatment of non-muscle invasive bladder cancer: a focus on intravesical therapy

Kassouf

Kamat

Zlotta

et al. 2013

CUAJ

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Effect of Routine Repeat Transurethral Resection for Superficial Bladder Cancer: A Long-term Observational Study

Abstract: These data suggest a favorable outcome regarding recurrence and progression in patients with superficial bladder cancer who undergo ReTURB. ReTURB is suggested at least in those at high risk when bladder preservation is intended.

Cited by 268 publications

References 17 publications

Influence of the Presence of Muscularis Propria on Recurrence and the Quality of Transurethral Resection in Low-Grade, Stage pTa Bladder Tumors

Influence of the Presence of Muscularis Propria on Recurrence and the Quality of Transurethral Resection in Low-Grade, Stage pTa Bladder Tumors

Effect of Age on Outcome of High-Risk Non-Muscle-Invasive Bladder Cancer Patients Treated with Second Transurethral Resection and Maintenance Bacillus Calmette-Guerin Therapy

Canadian guidelines for treatment of non-muscle invasive bladder cancer: a focus on intravesical therapy

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