Clinical significance and analysis of risk factors of second transurethral resection of non-muscle invasive bladder cancer / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the clinical significance of second transurethral resection of bladder tumor and analyze the related risk factors of recurrence and progression of bladder tumor.Methods A retrospective analysis of 171 patients including 134 males and 37 females.95 patients were enrolled in single TURBT group.The patients were (64.4 ± 10.7) years old.Their mean body mass index (BMI) was (23.5 ± 3.0) kg/m2 and mean tumor diameter was (24.7 ± 8.8) mm.67 cases were diagnosed with Ta stage and 28 cases were diagnosed with T1 stage.There were 44 cases diagnosed with low grade tumor and 51 cases with high grade tumor.76 patients were enrolled in second TURBT group.The patients were (66.0 ± 9.2) years old.Their mean BMI was (23.7 ± 3.0) kg/m2 and mean tumor diameter was (25.3 ± 9.3)mm.44 cases were diagnosed with Ta stage and 32 cases were diagnosed with T1 stage.There were 41 cases diagnosed with low grade tumor and 35 cases with high grade tumor.There was no significant difference between the two groups(P ＞ 0.05).General anesthesia was used for the operation,and the patient was in lithotomy position.For the first TURBT,the standard transurethral resection method was used to resect the tumor and the surrounding mucosa 1-2 cm far from tumor.The tumor size,location and number were recorded.The second resection was performed 2 to 12 weeks after the operation,and the basal part of the original tumor,the inflammatory edema mucosa around the original tumor and other suspicious tumor sites were sequentially removed.Both groups received immediate intravesical instillation chemotherapy with epirubicin or gemcitabine within 24 hours after surgery.The perfusion protocol was started once a week for 8 times;then once a month upto 1 year after surgery.Univariate and multivariate analysis were used to analyze the related factors of bladder tumor residual after first TURBT and the related risk factors of postoperative recurrence and progression.The time of second TURBT was analyzed.The Kaplan-meier method was used to draw the survival curve and analyze the effect of secondary resection on the survival of patients with bladder tumor.Results 17 cases of residual tumor were found in the second TURBT group,including 9 cases with Ta stage and 8 cases with T1 stage.Among them,5 cases in Ta stage were upgraded to T1 stage,and the remaining 12 cases keep the same pathological stage.There was no significant difference in the residual rate between Ta and T1 (11.8％ vs.10.5％,P ＞ 0.05).Multivariate analysis showed that the number of tumors (OR 4.255,95％ CI 1.186-16.124,P =0.034),tumor size (OR 7.800,95％ CI 1.852-32.841,P =0.005),and pathological grade (OR 3.764,95％ CI 0.947-14.968,P =0.006) were risk factors for residual tumor.Univariate analysis showed that secondary TURBT,BMI,tumor size,clinical stage,and pathological grade were the influencing factors of bladder tumor recurrence and progression (P ＜ 0.05).Multivariate analysis showed that single TURBT (OR 0.25,95％ CI 0.135-0.561,P =0.000),tumor diameter ≥ 30 mm (OR 3.548,95 ％ CI 1.899-6.629,P =0.000),high grade tumor (OR 2.62,95％ CI 1.026-4.990,P =0.043) are independent risk factors for tumor recurrence.Single TURBT (OR 0.114,95％ CI 0.033-0.391,P =0.001),tumor diameter ≥ 30 mm (OR 4.026,95％ CI 1.628-9.956,P =0.003),clinical stage T1 (OR 5.623,95％ CI 1.818-17.385,P =0.003) are independent risk factors for tumor progression.The recurrence-free survival time of the first and second resection intervals ≤6 weeks and ＞ 6 weeks was 22.6 months and 17.8 months,respectively (P ＜ 0.05),and the progression-free survival time was 23.4 months and 22.3,respectively (P ＞ 0.05).The follow-up period was 3 to 31 months with an average of 16.7 months.The recurrence-free survival time of the single TURBT group and the second TURBT group was 19.4 months and 23.8 months,respectively (P ＜ 0.05).Tumor progression occurred in 25 patients with 22 in the single TURBT group and 3 in the second TURBT group.The progression-free survival time was 22.1 months and 24.7 months,respectively (P ＜ 0.05).Conclusions Second transurethral resection of bladder tumor can reduce postoperative residual tumor,postpone postoperative recurrence and progression,and improve prognosis of the patients.