Development of a predictive model for optimizing the selection of patients for second transurethral resection bladder
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v83i1.971Keywords:
Urinary bladder neoplasms, neoplasm recurrence, residual neoplasm, reoperationAbstract
Background: Transurethral resection of bladder (TURB) is considered the gold standard treatment of non-muscle invasive bladder tumor (NMIBT). The urological clinical practice guidelines recommend second-TURB (re-TURB), in certain situations, to achieve a complete resection and appropriately stratify the tumor.
Objective: To design a predictive model of residual tumor in re-TURB, to optimize patient selection and avoid unnecessary surgeries.
Methods: Retrospective analysis of 413 NMIBT with a macroscopically complete TURB and identification of the muscle layer, with subsequent re-TURB (2-6 weeks), according to EAU Clinical Guidelines criteria, from January 2010 to December 2021.
We have identified predictive variables of residual tumor through univariate and multivariate analysis using logistic regression. The evaluation of the exactitude of the predictive model has been made using AUC (area under curve-ROC curve).
Results: Median age in the series was 74 (38-91) years old, and 86.7% were male. Tumors that required second-TURB were mostly primary (64.6%), stage T1 (84.5%), high grade (82.6%), multifocal (54.8%) and with a size less than 3 cm (73.1%). Residual tumor was found in 28.1% of re-TURB. The independent predictors factors of residual tumor identified were: recurrence tumor (OR 1.87; IQ 1.14-3.06, p=0.01) and multifocality tumors (OR 2.11; IQ 1.31-3.4; p=0.002). High-grade shows a trend to statistical signification as risk factor (p=0.07) and early administration of mitomycin-C behaved as an independent protector factor (OR 0.40; IQ 0.3-0.81; p=0.006). The predictive model shows an AUC=0.7 (IQ 0.62-0.73; p=0.0001).
Conclusion: Our predictive model evaluates the probability of finding residual tumor in second-TURB with a 70% accuracy. This way, we could optimize the selection of patients in low risk of residual tumor, thus avoiding unnecessary surgeries.
References
Rouprêt M, Babjuk M, Böhle A, Burger M, Compérat E, Cowan N, et al. Upper Urinary Tract Urothelial Carcinoma. Non-muscle-invasive Bladder Cancer (TaT1 and CIS). Guidelines. 2021 Apr 1. [accessed 21 Feb 2023] Available from: https://bladder.uroonco.uroweb.org/guideline/upper-urinary-tract-urothelial-cell-carcinoma/
Cumberbatch MGK, Foerster B, Catto JWF, Kamat AM, Kassouf W, Jubber I, et al. Repeat Transurethral Resection in Non-muscle-invasive Bladder Cancer: A Systematic Review. Eur Urol. 2018 Jun;73(6):925–33. doi: 10.1016/j.eururo.2018.02.014
Naselli A, Hurle R, Paparella S, Buffi NM, Lughezzani G, Lista G, et al. Role of Restaging Transurethral Resection for T1 Non-muscle invasive Bladder Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus. 2018 Jul;4(4):558–67. doi: 10.1016/j.euf.2016.12.011
Chang SS, Boorjian SA, Chou R, Clark PE, Daneshmand S, Konety BR, et al. Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline. J Urol. 2016 Oct;196(4):1021–9. doi: 10.1016/j.juro.2016.06.049
Bansal A, Sankhwar S, Goel A, Kumar M, Purkait B, Aeron R. Grading of complications of transurethral resection of bladder tumor using Clavien-Dindo classification system. Indian J Urol. 2016;32(3):232–7. doi: 10.4103/0970-1591.185104
Brierley JD, Gospodarowicz MK, Wittekind C, editors. TNM Classification of Malignant Tumours, 8th edition | UICC. 8th ed. Ginebra: Union for International Cancer Control/Wiley Publications; 2016. [accessed 21 Feb 2023] Available from: https://www.uicc.org/resources/tnm-classification-malignant-tumours-8th-edition
Sylvester RJ, van der Meijden APM, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006 Mar;49(3):466–465; discussion 475-477. doi: 10.1016/j.eururo.2005.12.031
Gendy R, Delprado W, Brenner P, Brooks A, Coombes G, Cozzi P, et al. Repeat transurethral resection for non-muscle-invasive bladder cancer: a contemporary series. BJU Int. 2016 Apr;117 Suppl 4:54–9. doi: 10.1111/bju.13265
Dobruch J, Borówka A, Herr HW. Clinical value of transurethral second resection of bladder tumor: systematic review. Urology. 2014 Oct;84(4):881–5. doi: 10.1016/j.urology.2014.06.005
Chamlati-Cuello JM, Garza-Gangemi AM, Gonzaga-Carlos N, Iturriaga-Goyón E, Castillejos-Molina RA. Second-look histopathologic results in non-muscle-invasive urothelial carcinoma of the bladder: Is repeat resection necessary? Rev Mex Urol. 2017 Jul 17;77(3):183–90.
Rosales Fajardo L, Santana Sarrhy LS, Cinta Alejo y Dreyde R. Resultados de la re-RTU en el tumor de vejiga no musculo- invasivo de alto grado. Revista Cubana de Urología. 2014 Jan 28;2(2). [accessed 21 Feb 2023] Available from: https://revurologia.sld.cu/index.php/rcu/article/view/189
Akand M, Muilwijk T, Raskin Y, De Vrieze M, Joniau S, Van Der Aa F. Quality Control Indicators for Transurethral Resection of Non–Muscle-Invasive Bladder Cancer. Clinical Genitourinary Cancer. 2019 Aug 1;17(4):e784–92. doi: 10.1016/j.clgc.2019.04.014
Pisano F, Gontero P, Sylvester R, Joniau S, Serretta V, Larré S, et al. Factores de riesgo de enfermedad residual en la re-RTU en una gran cohorte de pacientes con enfermedad T1G3. Actas Urológicas Españolas. 2021 Jul 1;45(6):473–8. doi: 10.1016/j.acuro.2020.08.016
Gontero P, Sylvester R, Pisano F, Joniau S, Oderda M, Serretta V, et al. The impact of re-transurethral resection on clinical outcomes in a large multicentre cohort of patients with T1 high-grade/Grade 3 bladder cancer treated with bacille Calmette-Guérin. BJU Int. 2016 Jul;118(1):44–52. doi: 10.1111/bju.13354
Akitake M, Yamaguchi A, Shiota M, Imada K, Tatsugami K, Yokomizo A, et al. Predictive Factors for Residual Cancer in Second Transurethral Resection for Non-muscle-invasive Bladder Cancer. Anticancer Res. 2019 Aug;39(8):4325–8. doi: 10.21873/anticanres.13598
Divrik RT, Yildirim U, Zorlu F, Ozen H. The effect of repeat transurethral resection on recurrence and progression rates in patients with T1 tumors of the bladder who received intravesical mitomycin: a prospective, randomized clinical trial. J Urol. 2006 May;175(5):1641–4. doi: 10.1016/S0022-5347(05)01002-5
Ferro M, Di Lorenzo G, Buonerba C, Lucarelli G, Russo GI, Cantiello F, et al. Predictors of Residual T1 High Grade on Re-Transurethral Resection in a Large Multi-Institutional Cohort of Patients with Primary T1 High-Grade/Grade 3 Bladder Cancer. J Cancer. 2018;9(22):4250–4. doi: 10.7150/jca.26129
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