646 SECOND-TUR OF INITIAL HIGH GRADE T1 BLADDER CANCER AFTER-BCG AND ACCORDING TO LAMINA PROPRIA INVASION MICROSTAGING (T1 A/B)

e17018 Background: Second transurethral resection (TUR), which is now recommended for all T1 high-grade bladder urothelial carcinoma, may not be necessary for patients with minimal tumor burden at the first TUR. T1 microstaging by the recognition of the muscularis mucosae or vascular plexus may be one promising method for evaluating tumor burden, but is sometimes technically difficult to assess. The number of TUR chips with tumor invading into lamina propria (T1chips) is easy to assess and can be available for all patients with T1 bladder urothelial carcinoma. Our aim was to determine clinicopathological factors which can predict the existence of residual tumor on the second TUR specimens for T1 high-grade bladder urothelial carcinoma. Methods: A total of 50 patients were diagnosed with T1 high-grade bladder urothelial carcinoma after the first TUR. We performed second TUR for the 50 patients. The median interval from the first and the second TUR was 6 week (range, 2-10). Voided urine cytology was taken in all patients between the first and the second TUR, at least 1 week after the first TUR. The existence of proper muscle tissue was confirmed in all specimens for the first and the second TUR. Tumor size, the number of tumor, the presence of carcinoma in situ (CIS), the number of TUR chips containing lamina propria invasion (T1chips) were recorded for the first TUR specimens. Results: A total of 20 (40%) patients had residual tumor on the second TUR. The second TUR stage was: T0 30 (60%); Ta/is 7 (14%); T1 9 (18%); and T2 4 (8%), respectively. In univariate analysis, positive urine cytology before the first TUR (48% vs 0% in negative), positive urine cytology between the first and second TUR (76% vs 21% in negative), and multiple T1 chips on the first TUR specimens (58% vs 6% in one T1 chip) were associated with residual tumor on the second TUR. In addition, in multivariate analysis, the number of T1 chips on the first TUR and urine cytology between the first and the second TUR were the significant predictors for residual tumor on the second TUR. Of 15 patients with multiple T1 chips and positive urine cytology between the first and the second TUR, 13 (87%) had residual tumor on the second TUR, compared to 0% (0/15) in those with one T1 chip and negative urine cytology between the first and the second TUR. Conclusions: Second TUR may not be necessary for all patients with T1 high-grade bladder urothelial carcinoma. The number of T1 chips on the first TUR and urine cytology between the first and the second TUR are useful factors for predicting second TUR stage.

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Treatment and management of high-grade T1 bladder cancer: what should we do after second TUR?

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyu219 ◽

2015 ◽

Vol 45 (4) ◽

pp. 315-322 ◽

Cited By ~ 7

Author(s):

H. Kitamura ◽

Y. Kakehi

Keyword(s):

Bladder Cancer ◽

High Grade ◽

Second Tur

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Risk Factors for Intravesical Recurrence in Patients with High-grade T1 Bladder Cancer in the Second TUR Era

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyt016 ◽

2013 ◽

Vol 43 (4) ◽

pp. 404-409 ◽

Cited By ~ 11

Author(s):

Ei-ichiro Takaoka ◽

Yoshiyuki Matsui ◽

Takamitsu Inoue ◽

Jun Miyazaki ◽

Masakazu Nakashima ◽

...

Keyword(s):

Risk Factors ◽

Bladder Cancer ◽

High Grade ◽

Second Tur

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Improving Selection Criteria for Early Cystectomy in High-Grade T1 Bladder Cancer: A Meta-Analysis of 15,215 Patients

Journal of Clinical Oncology ◽

10.1200/jco.2014.57.6967 ◽

2015 ◽

Vol 33 (6) ◽

pp. 643-650 ◽

Cited By ~ 102

Author(s):

William Martin-Doyle ◽

Jeffrey J. Leow ◽

Anna Orsola ◽

Steven L. Chang ◽

Joaquim Bellmunt

Keyword(s):

Risk Factors ◽

Bladder Cancer ◽

Prognostic Factors ◽

Lamina Propria ◽

Selection Criteria ◽

Meta Analysis ◽

Depth Of Invasion ◽

Cochrane Central Register ◽

High Grade ◽

Cancer Specific Survival

Purpose High-grade T1 (HGT1) bladder cancer is the highest risk subtype of non–muscle-invasive bladder cancer, with highly variable prognosis, poorly understood risk factors, and considerable debate about the role of early cystectomy. We aimed to address these questions through a meta-analysis of outcomes and prognostic factors. Methods PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and American Society of Clinical Oncology abstracts were searched for cohort studies in HGT1. We pooled data on recurrence, progression, and cancer-specific survival from 73 studies. Results Five-year rates of recurrence, progression, and cancer-specific survival were 42% (95% CI, 39% to 45%), 21% (95% CI, 18% to 23%), and 87% (95% CI, 85% to 89%), respectively (56 studies, n = 15,215). In the prognostic factor meta-analysis (33 studies, n = 8,880), the highest impact risk factor was depth of invasion (T1b/c) into lamina propria (progression: hazard ratio [HR], 3.34; P < .001; cancer-specific survival: HR, 2.02; P = .001). Several other previously proposed factors also predicted progression and cancer-specific survival (lymphovascular invasion, associated carcinoma in situ, nonuse of bacillus Calmette-Guérin, tumor size > 3 cm, and older age; HRs for progression between 1.32 and 2.88, P ≤ .002; HRs for cancer-specific survival between 1.28 and 2.08, P ≤ .02). Conclusion In this large analysis of outcomes and prognostic factors in HGT1 bladder cancer, deep lamina propria invasion had the largest negative impact, and other previously proposed prognostic factors were also confirmed. These factors should be used for prognostication and patient stratification in future clinical trials, and depth of invasion should be considered for inclusion in TNM staging criteria. This meta-analysis can also help define selection criteria for early cystectomy in HGT1 bladder cancer, particularly for patients with deep lamina propria invasion combined with other risk factors.

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