Management of high-grade papillary Ta or T1 bladder cancer after restaging transurethral resection: A retrospective study comparing Bacillus Calmette-Guerin therapy upfront versus a third resection.
Q Arnaud, P Sebe, A Colau, M Mouton, F Desgrandchamps, A Masson-Lecomte, T Bessede, J Irani, I Dominique
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引用次数: 0
Abstract
Purpose: Performing restaging transurethral bladder resection (reTURB) for high-risk non-muscle invasive bladder cancer (NMIBC) reduces the risk of recurrence and tumour understaging. Management of residual high-grade papillary Ta or T1 after reTURB has changed this last 10years in international recommendations. This study aimed to compare the recurrence free survival according to the different management procedures performed.
Materials and methods: Patients who underwent reTURB for initial high-risk NMIBC between 2011 and 2020 were included. Patients with residual high-grade papillary Ta or T1 tumour after reTURB were divided into two groups: BCG instillations upfront versus BCG following a third-look resection (3TURB). Patient and tumour characteristics, BCG instillations, recurrence-free survival were retrospectively analysed.
Results: A total of 162 high-risk patients were included. Sixty-one (37.7%) had residual high-grade papillary Ta or T1 at reTURB: 35 (21.6%) had BCG instillations upfront, 18 (11.2%) had a 3TURB and 8 (5%) had other management. The mean follow-up was 34.2weeks±20.2. Recurrence-free survival was significantly better in patients who underwent BCG instillations upfront (P<0.0043). Recurrence after BCG therapy following reTURB was significantly lower in patients with no residual NMIBC at 6 (92.5% vs. 72.4%, P<0.004) and 12months (85% vs. 67.3%, P<0.03).
Conclusions: The efficacy of intravesical BCG is compromised in case of residual tumour following TURB. The role of a 3TURB following a positive reTURB is not yet determined. This study has confirmed that residual tumor following reTURB is a negative predictive factor but could not demonstrate the value of a 3TURB compared to upfront BCG.
期刊介绍：
Une publication rapide des travaux en urologie: retrouvez les derniers travaux de recherche, études et enquêtes, en Urologie, publiés sous la forme de revues, mises au point, articles originaux, notes techniques, cas cliniques pertinents et originaux, lettres à la rédaction, revues de la littérature, textes de recommandation,... La revue publie également des articles pour les infirmières en Urologie. Une approche pluridisciplinaire : Progrès en Urologie aborde toutes les pathologies urologiques. Aux 13 numéros de Progrès viennent s''ajouter 4 numéros de Progrès en Urologie Pelvi-Périnéologie
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