Effect of Complete Transurethral Resection on Oncologic Outcomes After Radiation Therapy for Muscle-Invasive Bladder Cancer

IF 6.4 1区医学 Q1 ONCOLOGY International Journal of Radiation Oncology Biology Physics Pub Date : 2025-02-01 DOI:10.1016/j.ijrobp.2024.08.036

Pier Paolo Avolio MD , Ronald Kool MD , Bobby Shayegan MD , Gautier Marcq MD , Peter C. Black MD , Rodney H. Breau MD , Michael Kim MD , Ionut Busca MD , Hamidreza Abdi MD , Mark Dawidek MD , Michael Uy MD , Gagan Fervaha MD , Fabio L. Cury MD , Rafael Sanchez-Salas MD , Nimira Alimohamed MD , Jonathan Izawa MD , Claudio Jeldres MD , Ricardo Rendon MD , Robert Siemens MD , Girish S. Kulkarni MD , Wassim Kassouf MD

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Abstract

Purpose

To compare the oncologic outcomes of patients with nonmetastatic muscle-invasive bladder cancer (MIBC) undergoing complete versus incomplete transurethral tumor resection (TURBT) before radiation therapy.

Methods and Materials

Patients with nonmetastatic MIBC who underwent curative-intent radiation therapy between 2002 and 2018 at 10 Canadian institutions were retrospectively evaluated. Inverse probability of treatment weighting was performed using baseline characteristics. Differences in survival outcomes by complete and incomplete TURBT were analyzed.

Results

Of the 757 patients included, 66% (498) had documentation of a complete and 34% (259) an incomplete TURBT. Before adjustment, 121 (47%) and 45 (9%) patients who underwent incomplete and complete TURBT, respectively, were diagnosed with cT3-4 tumor (P <.001). After weight-adjustment, all baseline cohort characteristics were balanced (absolute standardized differences < 0.1). The adjusted median follow-up was 27 months. Adjusted survival analyses showed no significant difference in 5-year overall survival (48% vs 52%, 1.03 [0.82-1.29]; P = .8), cancer-specific survival (64% vs 61%, 0.93 [0.70-1.25]; P = .7), metastasis-free survival (43% vs 46%, 0.97 [0.79-1.19]; P = .8), and disease-free survival (32% vs 35%, 0.95 [0.79-1.15]; P = .7) between the 2 groups.

Conclusions

Complete TURBT may be associated with clinical organ-confined disease. Extent of TURBT was not independently associated with oncologic outcomes in patients with MIBC treated with radiation therapy.

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完全经尿道切除术对肌肉浸润性膀胱癌放疗后肿瘤学结果的影响：放射治疗中的经尿道切除术。

目的：比较非转移性肌浸润性膀胱癌（MIBC）患者在放疗前接受完全经尿道肿瘤切除术（TURBT）与不完全经尿道肿瘤切除术（TURBT）的肿瘤治疗效果：回顾性评估了2002年至2018年期间在加拿大十家医疗机构接受治愈性放射治疗的非转移性肌浸润性膀胱癌患者。利用基线特征对治疗的反概率进行了加权。结果：在纳入的757例患者中，66%（498例）有完整TURBT记录，34%（259例）有不完整TURBT记录。调整前，分别有121名（47%）和45名（9%）接受不完全TURBT和完全TURBT的患者被诊断为cT3-4肿瘤（p < 0.001）。经过权重调整后，所有基线队列特征均保持平衡（绝对标准化差异<0.1）。调整后的中位随访时间为27个月。调整后的生存分析表明，5年总生存率（48% vs 52%，1.03 [0.82-1.29]; p = 0.8）、癌症特异性生存率（64% vs 61%，0.93 [0.70-1.25]；P = 0.7）、无转移生存率（43% vs 46%，0.97 [0.79-1.19]；P = 0.8）和无病生存率（32% vs 35%，0.95 [0.79-1.15]；P = 0.7）：结论：完全TURBT可能与临床器官局限性疾病有关。结论：完全TURBT可能与临床器官封闭性疾病有关，TURBT的范围与接受放射治疗的MIBC患者的肿瘤预后无关。

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来源期刊

International Journal of Radiation Oncology Biology Physics 医学-核医学

CiteScore

11.00

自引率

7.10%

发文量

2538

审稿时长

6.6 weeks

期刊介绍： International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field. This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.