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

Tae, Bum Sik; Jeong, Chang Wook; Kwak, Cheol; Kim, Hyeon Hoe; Moon, Kyung Chul; Ku, Ja Hyeon

doi:10.1371/journal.pone.0189354

Cited by 14 publications

(10 citation statements)

References 21 publications

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“…While other investigators have reported a lower rate of persistent disease, even in the best hands, residual disease remains in one of three patients, even when all first resections are deemed macroscopically complete ( 31 - 35 ). Even for pTa high-grade and low-grade cancers the rates of residual disease are as high as 41.4% ( 36 ) and 33.3%, respectively ( 37 ). When including patients with multiple negative prognostic factors, Kim et al found that almost all patients had residual cancer at second look TURB ( 26 ).…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Second, second look TURB pathology not only allows to identify patients who have a MIBC but also helps identify those who have NMIBC but are likely to fail BCG therapy and should, therefore, be considered for early radical cystectomy. Second look TURB pathology has, indeed, a strong prognostic value and is considered by some clinicians as the most significant predictor of early recurrence and progression ( 28 , 37 , 42 ). In a dataset of 710 NMIBC patients, Herr et al have reported that a T1 at second look TURB yields a progression rate of 76% within 5 years ( 2 ).…”

Section: Evidence Synthesismentioning

confidence: 99%

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The rational and benefits of the second look transurethral resection of the bladder for T1 high grade bladder cancer

Soria

Marra

D’Andrea

2019

Transl. Androl. Urol

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The second look transurethral resection of the bladder (TURB) represents a fundamental step in the treatment of papillary non-muscle invasive bladder cancer (NMIBC); it is therefore recommended by all guidelines. However, not all the literature agrees on its staging value and its ability to improve oncological outcomes of patients. Therefore, the purpose of this review is to evaluate the strengths and weaknesses of second look TURB, trying to depict its evolving role in the management of high grade NMIBC. Using Medline, a non-systematic review was performed including articles between January 2000 and June 2018. English language original articles, reviews and editorials were selected based on their clinical relevance. To date, TURB seems to be largely inadequate in retrieving a correct diagnosis and in removing all tumor tissue. Second look TURB maximizes staging accuracy, allows to clear residual cancer and yields prognostic advantages allowing key information to identify possible candidates for immediate radical cystectomy for very high risk T1HG tumors. Moreover, it seems to have a therapeutic benefit by improving recurrence- and progression-free survivals. However, few recent large studies showed that these advantages seem to be limited to patients without detrusor muscle present at first resection. Similarly, the presence of residual disease and the risk of upstaging are related to the presence of detrusor muscle in specimen. It could well be that in the future the presence of detrusor muscle would be a quality criteria to avoid an unnecessary second look TURB as shown by recent studies using the en-bloc resection technique. Finally, it has to be underlined that this is a surgical procedure not free of risks and complications and with a non-negligible impact on patients’ quality of life, waiting lists and healthcare costs. Therefore, future studies trying to identify the criteria that may better allow which patients to select for a second look TURB while avoiding an unnecessary intervention with possible risks and associated cost are needed to allow a personalized approach to even this one size fits all strategy.

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Section: Evidence Synthesismentioning

confidence: 99%

Section: Evidence Synthesismentioning

confidence: 99%

The rational and benefits of the second look transurethral resection of the bladder for T1 high grade bladder cancer

Soria

Marra

D’Andrea

2019

Transl. Androl. Urol

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“…The recurrence rate can reach about 50% -70% within 1 year after surgery, even 10% -30% of patients progressed to muscle-invasive stage or metastasize to a distant place 26 ; 27 . Although novel diagnostic and treatment was implemented, the ve-year survival rates for bladder cancer has been no improvement since the 1990s 28 .…”

Section: Discussionmentioning

confidence: 99%

Identification and Prognostic Analysis of Hub Genes in Bladder Cancer

Huang

Liu²,

Song³

et al. 2020

Preprint

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Abstract Background:Bladder cancer(BC) is one of the most common tumors worldwide. Its incidence and mortality rate rank first in urological malignancies. Due to the lack of credible predictors, most patients are not timely diagnosed and treated. Moreover, in the past 30 years, the clinical treatment of BC had seen little progress, and the 5-year survival rates of patients were flat.Therefore,identifying novel potential markers or therapeutic targets are urgently required for the diagnosis and prognosis of BC.Methods: The BC gene expression chip data （GSE121711）were downloaded from the GEO database and the BLCA RNA-seq data were downloaded from the TCGA database. The differentially expressed genes (DEGs) were identified by R software using limma package and the edgeR package, and obtained the overlapped DEGs from two databases. Then, the Gene Ontology(GO) function analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of overlapped DEGs were performed through DAVID database, and the protein–protein interaction(PPI) network was constructed to screen Hub genes for regulatory protein expression in BC. Expression and prognostic analysis of the hub genes were performed by UALCAN and Kaplan-Meier plotter.Results: A total of 372 overlap DEGs were obtained, of which 93 were up-regulated and 279 were down-regulated. These genes were mainly associated with the function and pathway enrichment such as glycosaminoglycan binding, vasculature development, Cell cycle, Proteoglycans in cancer. The protein-protein interaction network analysis obtained 12 hub genes. Among these hub genes，HMMR，NCAPG2，SMC4, TROAP were closely related to the survival rate of bladder cancer patients revealed that these genes might be the key genes play an important role in the occurrence and progression.Conclusion:Therefore, our current studies demonstrated thatHMMR, NCAPG2, SMC4, TROAP are potential prognostic biomarkers for BC.In the future, these may also become clinical therapeutic targets.

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“…In a prospective randomized study comparing BCG with epirubicin and interferon-α2b in patients with T1 residual tumor on re-TUR was significantly associated with an increased risk of recurrence as well as treatment failure [31]. Various mono-center studies confirmed that residual tumor on re-TUR is a harbinger for disease recurrence and progression compared to pT0 on re-TUR [32,33]. Disease progression of NMIBC is usually associated with worse survival compared to the novo MIBC [34].…”

Section: 6mentioning

confidence: 99%

High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes: Results of a Multi-Institutional Study

et al. 2018

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Introduction: The aim of this multicenter study was to investigate the prognostic impact of residual T1 high-grade (HG)/G3 tumors at re-transurethral resection (TUR of bladder tumor) in a large multi-institutional cohort of patients with primary T1 HG/G3 bladder cancer (BC). Patients and Methods: The study period was from January 2002 to December 2012. A total of 1,046 patients with primary T1 HG/G3 and who had non-muscle invasive BC (NMIBC) on re-TUR followed by adjuvant intravesical Bacillus Calmette-Guerin (BCG) therapy with maintenance were included. Endpoints were time to disease recurrence, progression, and overall and cancer-specific death. Results: A total of 257 (24.6%) patients had residual T1 HG/G3 tumors. The presence of concomitant carcinoma in situ, multiple and large tumors (> 3 cm) at first TUR were associated with residual T1 HG/G3. Five-year recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were 17% (CI 11.8–23); 58.2% (CI 50.7–65); 73.7% (CI 66.3–79.7); and 84.5% (CI 77.8–89.3), respectively, in patients with residual T1 HG/G3, compared to 36.7% (CI 32.8–40.6); 71.4% (CI 67.3–75.2); 89.8% (CI 86.6–92.3); and 95.7% (CI 93.4–97.3), respectively, in patients with NMIBC other than T1 HG/G3 or T0 tumors. Residual T1 HG/G3 was independently associated with RFS, PFS, OS, and CSS in multivariable analyses. Conclusions: Residual T1 HG/G3 tumor at re-TUR confers worse prognosis in patients with primary T1 HG/G3 treated with maintenance BCG. Patients with residual T1 HG/G3 for primary T1 HG/G3 are very likely to fail BCG therapy alone.

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

Cited by 14 publications

References 21 publications

The rational and benefits of the second look transurethral resection of the bladder for T1 high grade bladder cancer

The rational and benefits of the second look transurethral resection of the bladder for T1 high grade bladder cancer

Identification and Prognostic Analysis of Hub Genes in Bladder Cancer

High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes: Results of a Multi-Institutional Study

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