Pathology in repeated transurethral resection of a bladder tumor as a risk factor for prognosis of high-risk non-muscle-invasive bladder cancer

The prognostic value of repeat transurethral resection of bladder tumor (TURBT) in patients with diagnosed high-risk, non-muscle-invasive bladder cancer (NMIBC) was investigated. We retrospectively reviewed the medical records of patients treated from October 2004 to December 2013 at Seoul National University who underwent repeated TURBT within 2–6 weeks after an initial resection. The study enrolled patients who had been diagnosed with NMIBC at both the initial and repeat TURBT; patients with muscle-invasive tumors on repeat TURBT were excluded. We used stepwise multivariate Cox regression models stratified by study to assess the independent effects of the predictive factors and estimated hazard ratios (HRs) from the Cox models. We investigated a total of 198 patients who were diagnosed with high-risk NMIBC. In logistic regression analyses, number of bladder tumors (2–7: OR, 2.319; 8≤: OR, 3.353; p<0.05), initially high tumor grade (OR, 2.435; p = 0.040), and presence of carcinoma in situ lesion (OR, 3.639; p = 0.017) correlated with residual tumor in the repeated-TURBT specimen. T1 stage in repeated-TURBT significantly correlated with recurrence (HR, 1.837; p = 0.010) and progression (HR, 2.806; p = 0.029) in multivariate analysis. The high grades of tumors in repeated-TURBT also significantly correlated with progression but not recurrence in the multivariate analysis (HR 2.152; p = 0.008). In this study, the pathologic findings in repeated-TURBT correlated with recurrence and progression in high-risk NMIBC. Repeated-TURBT is valuable because it can predict the recurrence and progression of high-risk NMIBC in addition to obtaining accurate pathologic findings.

本研究旨在探讨重复经尿道膀胱肿瘤切除术（transurethral resection of bladder tumor, TURBT）对已确诊高危非肌层浸润性膀胱癌（non-muscle-invasive bladder cancer, NMIBC）患者的预后价值。我们回顾性分析了2004年10月至2013年12月在首尔国立大学接受治疗的患者病历，这些患者在初次膀胱肿瘤切除术后2~6周内接受了重复TURBT。本研究纳入初次及重复TURBT均确诊为非肌层浸润性膀胱癌的患者，排除重复TURBT提示肌层浸润性肿瘤的患者。我们采用按研究分层的逐步多因素Cox回归模型，评估预测因子的独立影响，并通过Cox模型估算风险比（hazard ratio, HR）。本研究共纳入198例确诊为高危非肌层浸润性膀胱癌的患者。Logistic回归分析显示，膀胱肿瘤数目（2~7枚：比值比[OR]=2.319；≥8枚：OR=3.353；p<0.05）、初始肿瘤高分级（OR=2.435；p=0.040）以及原位癌病灶存在（OR=3.639；p=0.017）与重复TURBT标本中的残留肿瘤显著相关。多因素分析结果显示，重复TURBT标本提示T1分期与肿瘤复发（HR=1.837；p=0.010）及肿瘤进展（HR=2.806；p=0.029）显著相关。重复TURBT标本中肿瘤高分级同样与肿瘤进展显著相关，但与肿瘤复发无显著关联（HR=2.152；p=0.008）。本研究表明，重复TURBT的病理特征与高危非肌层浸润性膀胱癌的复发及进展密切相关。重复TURBT具有重要临床价值，其不仅可获取准确的病理诊断结果，还可预测高危非肌层浸润性膀胱癌的复发与进展。