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

Ji Sung Shim, Hoon Choi, Tae Il Noh, Jong Hyun Tae, Sung Goo Yoon, Seok Ho Kang, Jae Hyun Bae, Hong Seok Park, Jae Young Park

Research output: Contribution to journalArticle

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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 ≥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.

Original languageEnglish
Pages (from-to)429-434
Number of pages6
JournalKorean Journal of Urology
Volume56
Issue number6
DOIs
Publication statusPublished - 2015 Jan 1

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Urinary Bladder Neoplasms
Prospective Studies
Disease-Free Survival
Recurrence
Muscles
Neoplasms
Neoplasm Grading
Cystectomy
Residual Neoplasm
Survival Rate
Survival

Keywords

  • Neoplasm invasiveness
  • Recurrence
  • Urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

The clinical significance of a second transurethral resection for T1 high-grade bladder cancer : Results of a prospective study. / Shim, Ji Sung; Choi, Hoon; Noh, Tae Il; Tae, Jong Hyun; Yoon, Sung Goo; Kang, Seok Ho; Bae, Jae Hyun; Park, Hong Seok; Park, Jae Young.

In: Korean Journal of Urology, Vol. 56, No. 6, 01.01.2015, p. 429-434.

Research output: Contribution to journalArticle

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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 ≥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.",
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AU - Tae, Jong Hyun

AU - Yoon, Sung Goo

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