Risk Stratification for the Rate and Location of Residual Bladder Tumor for the Decision of Re-Transurethral Resection of Bladder Tumor

Abstract

IntroductionTo assess the rate and location of residual tumor in re-transurethral resection of bladder tumor (re-TURBT) and develop a risk stratification tool to assist clinicians in making treatment decisions.Patients and MethodsThe data of 144 patients with high-risk bladder cancer who received re-TURBT were retrospectively reviewed. The rate and location of residual tumors was recorded. Logistic regression was performed to explore risk factors for residual tumors, and a risk classification tool was developed.ResultsAmong the 144 patients, the rates of residual tumor and tumor location at the base of the primary tumor were 22.2% and 10.4%, respectively. Non-urothelial carcinoma subspecialist, piecemeal resection and the absence of detrusor muscle in the first specimen were defined as risk factors. Patients were categorized into low-, intermediate-, and high-risk groups according to the number of risk factors. The rate of residual tumor in the high-risk group was significantly higher than that in the low- and intermediate-risk groups (50% vs. 7.8%, P=0.001; 50% vs. 18.6%, P=0.002). Moreover, high-risk patients benefitted more from a second resection at the base of the primary tumor due to the high rate of residual tumor located at this site than low- and intermediate-risk patients (23.5% vs. 2.0%, P=0.002; 23.5% vs. 10.2%, P=0.083).ConclusionsRisk stratification based on the subspecialist category, operative method, and presence or absence of detrusor muscle in the first specimen could help identify patients who benefit from re-TURBT and second resection the base of the primary tumor.

A Systematic Review on the Role of Repeat Transurethral Resection after Initial en Bloc Resection for Non-Muscle Invasive Bladder Cancer

“…Table 2 summarizes the characteristics of the 12 eligible studies published from 2011 to 2022. Five of the studies were conducted in China [ 31 , 32 , 34 , 36 , 37 ], three in Italy [ 28 , 29 , 30 ] and one each in Egypt [ 33 ], Germany [ 27 ], Japan [ 38 ], and Poland [ 35 ]. All these studies were conducted in the last 12 years.…”

“… Forest plots of the rates of residual tumor ( A ) and tumor upstaging ( B ) detected by reTURB after initial ERBT [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. ES: effect size.…”

“…After screening titles and abstract found 25 articles relevant to the study aim, and therefore we retrieved the full-text ar After full-text analysis, another 13 studies were excluded for the following reasons lacked necessary data, two reported duplicated data, and only two studies only rep one patient. Finally, 12 studies fulfilled our eligibility criteria and were enrolled i review [27][28][29][30][31][32][33][34][35][36][37][38].…”

Sex Remains Negative Prognostic Factor in Contemporary Cohort of High-Risk Non-Muscle-Invasive Bladder Cancer

“…It has been recognized that women are at higher risk of detrusor muscle absence than men [ 21 ]. At the same time, the presence of detrusor muscle in tumor resections is associated with a lower risk of early recurrence [ 22 ]. In our study, rates of muscle tissue in primary resection specimens were greater in males (74%) than in females (56%).…”

Clinical and pathological risk factors for tumour recurrence and upstaging in second TURBT for patients with NMIBC: a systematic review and meta-analysis

“…As a result, 15 articles were excluded due to insufficient data identification. Finally, 18 studies were included in this meta-analysis [4,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22] and the detailed screening process was recorded in a flow diagram (▶ Abb. 1).…”