INTRODUCTION AND OBJECTIVES: Goals of transurethralresection of a bladder tumour (TUR) are to completely resect the lesionsand to make a correct diagnosis in order to adequately stage the patient.It is well known that the presence of detrusor muscle in thespecimen is a prerequisite to minimize the risk of under staging.Persistent disease after resection of bladder tumours is not uncommonand is the reason why the European Guidelines recommended a reTURfor all T1 tumours. It was recently published that when there ismuscle in the specimen, re-TUR does not influence progression orcancer specific survival. We present here the patient and tumour factorsthat may influence the presence of residual disease at re-TUR.METHODS: In our retrospective cohort of 2451 primary T1G3patients initially treated with BCG, pathology results for 934 patients(38.1%) who underwent re-TUR are available. 75.4% had multifocaltumours, 42.7% of tumours were more than 3 cm in diameter and 25.8%had concomitant CIS. We analyse this subgroup of patients who underwentre-TUR: there was no residual disease in 267 patients (28.6%)and residual disease in 667 patients (71.4%): Ta in 378 (40.5%) and T1in 289 (30.9%) patients. Age, gender, tumour status (primary/recurrent),previous intravesical therapy, tumour size, tumour multi-focality, presence of concomitant CIS, and muscle in the specimen were analysedin order to evaluate risk factors of residual disease at re-TUR,both in univariate analyses and multivariate logistic regressions.RESULTS: The following were not risk factors for residual disease:age, gender, tumour status and previous intravesical chemotherapy.The following were univariate risk factors for presence ofresidual disease: no muscle in TUR, multiple tumours, tumours > 3 cm,and presence of concomitant CISDue to the correlation between tumormulti-focality and tumor size, the multivariate model retained either thenumber of tumors or the tumor diameter (but not both), p < 0.001. Thepresence of muscle in the specimen was no longer significant, p ¼ 0.15,while the presence of CIS only remained significant in the model withtumor size, p < 0.001.CONCLUSIONS: The most significant factors for a higher risk ofresidual disease at re-TUR in T1G3 patients are multifocal tumours andtumours more than 3 cm. Patients with concomitant CIS and those withoutmuscle in the specimen also have a higher risk of residual disease.
|Numero di pagine||2|
|Stato di pubblicazione||Published - 2017|