Study The Related Factors Of Tumor Residual After TURBT And Recurrence After Second TURBT In Patients With T1 Bladder Cancer

Objective:To determine the residual tumor rate following initial transurethral resection of bladder tumor(TURBT)and the risk factors for recurrence following second TURBT in patients with T1 bladder cancer.Methods:The clinical data of patients with T1 bladder cancer who were admitted to our hospital from January 2015 to August 2022 were retrospectively analyzed.All patients underwent second TURBT within 2-8 weeks after the first TURBT.Binary Logistic regression analysis model was used to analyze the independent risk factors of tumor residual in T1 bladder cancer after initial TURBT.Cox regression analysis model was used to analyze the related factors of tumor recurrence after second transurethral resection of T1 bladder cancer.The RFS curve was drawn by Kaplan-Meier method to analyze the influence of each factor on RFS survival.Results:A total of 234 patients were enrolled,61 patients(26.1%)had residual tumor after second TURBT.The average follow-up time was 30(12-48)months,and 3 patients were not included in the recurrence follow-up because of incomplete bladder maintenance perfusion.The remaining 231 patients with T1 bladder cancer were included in the subsequent follow-up.During the average follow-up time of 30(12-48)months,79(34.2%)patients had recurrence,and 8(3.5%)of the recurrent patients had disease progression.Logistic regression analysis showed that the initial TURP without myometrium(OR=5.04,95%CI: 2.53-10.01,P < 0.001)and multiple tumors(OR=2.75,95%CI: 1.40-5.40,P=0.003)and tumor diameter ≥3cm(OR=2.64,95%CI:1.35-5.16,P=0.005)were independent risk factors for residual tumor after initial TURBT.Cox univariate analysis showed that multiple tumors(HR=1.88,95%CI: 1.21-2.93,P=0.005)and tumor recurrence(HR=1.92,95%CI: 1.19-3.11,P=0.008),residual tumor(HR=1.80,95%CI: 1.13-2.87,P= 0.014),and BCG intravesical infusion(HR=0.39,P=0.025)were significantly associated with RFS.Further multivariate analysis showed that tumor residual(HR=2.12,95%CI: 1.32-3.41,P=0.003),recurrent tumors(HR=1.99,95%CI: 1.23-3.21,P=0.005)and multiple tumors(HR=1.60,95%CI:1.03-2.51,P=0.039)and BCG maintenance intravesical instillation(HR=0.32,95%CI:0.14-0.74,P=0.008)were independent risk factors for RFS in patients with T1 bladder cancer.Kaplan-Meier survival curve showed that the 1,3,and 5-year RFS rates were76.5%,63.3% and 63.3%,respectively.Conclusion:1.Absence of muscle tissue in the initial TURBT specimen,multiple tumors and tumor diameter ≥3cm are independent risk factors for residual of the initial TURBT.Second TURBT is recommended for T1 bladder cancer patients with muscle tissue loss in the initial TURBT specimen,multiple tumors and tumor diameter ≥3cm.2.Residual tumor after initial TURBT,recurrent tumor and multiple tumors are independent risk factors for recurrence of T1 bladder cancer after second TURBT,and more rigorous follow-up measures can be carried out for these patients.BCG instillation after TURBT is a protective factor for the recurrence of T1 bladder cancer,which can reduce the recurrence rate of T1 bladder cancer.