Korean J Urol.  2015 Jun;56(6):429-434. 10.4111/kju.2015.56.6.429.

The clinical significance of a second transurethral resection for T1 high-grade bladder cancer: Results of a prospective study

• Shim JS
• Choi H
• Noh TI
• Tae JH
• Yoon SG
• Kang SH
• Bae JH
• Park HS
• Park JY

• KMID: 2160582
• DOI: http://doi.org/10.4111/kju.2015.56.6.429

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.

Keyword

Neoplasm invasiveness; Recurrence; Urinary bladder neoplasms

MeSH Terms

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

Figure

• 

  Fig. 1 (A) Kaplan-Meier curves of recurrence-free survival (RFS) in patients with residual tumor (green) and without residual tumor (blue) at the second transurethral resection of bladder tumor (TURBT). Three-year RFS was 68.6% and 50%, respectively (p=0.5). (B) Kaplan-Meier curves of progression-free survival (PFS) in patients with residual tumor (green) and without residual tumor (blue) at the second TURBT. Three-year PFS was 66.9% and 68.6%, respectively (p=0.976).

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