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MINERVA UROLOGICA E NEFROLOGICA
Rivista di Nefrologia e Urologia
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Urologica e Nefrologica 2014 December;66(4):233-40
The need for re-TUR of the bladder in non-muscle invasive bladder cancer: risk factors of tumor persistence in re-TUR specimens
Husillos Alonso A. 1, Rodríguez Fernández E. 2, Herranz Amo F. 2, López López E. 2, Aragón Chamizo J. 2, Ramírez Martínez D. 2, Durán Merino R. 2, Hernández Fernández C. 2 ✉
1 Hospital Universitario Infanta Elena, Hospital Universitario Fundación Jiménez Díaz, Valdemoro/Madrid, Spain;
2 Hospital General Universitario Gregorio Marañón, Madrid, Spain
AIM: This study evaluated the need for re-TUR of the bladder in non-muscle invasive bladder cancer (NMIBC) with complete transurethral resection (TUR) and examined the risk factors for disease occurrence in re-TUR of the bladder.
METHODS: A cohort of 211 patients diagnosed consecutively of NMIBC (July 2009 to October 2011) underwent re-TURB 4-6 weeks after the initial TURB. Association with tumor presence in re-TURB of the following parameters was analyzed: sex, primary/recurrent, number, size, stage, grade, association of carcinoma in situ, early instillation of Mitomycin C, and its classification according to the EORTC risk groups.
RESULTS: Fifty-seven (27%) cases exhibited residual tumors in the re-TURB and understaging was observed in 3 (1.4%) patients. The EORTC classified 151 (71.6%) patients as high risk; 124 (58.7%) patients received postoperative instillations of Mitomycin C. 31.8% of high risk patients exhibited tumors in the re-TUR compared to 14% of the low/intermediate risk (P<0.05). A total of 19.4% of patients with early instillation of Mitomycin C had tumor in re-TURB compared to 38.4% of patients without it (P<0.05). Multivariate analysis showed that high-risk tumors behaved as an independent risk factor for the tumor presence in re-TURB (HR=12.65, P=0.008), but early postoperative instillation of Mitomycin C was a protective factor (HR=2.16, P=0.02). The limitations of the study are the absence of randomization and its unicentric character.
CONCLUSION: Patients who were at a high risk of tumor recurrence and/or progression according to the EORTC classification exhibited a higher percentage of tumors in re-TURB. Therefore, these patients are optimal candidates for re-TURB.