The Clinical Efficacy Of Repeat Transurethral Resection(reTUR) In The Management Of Bladder Cancer And The Risk Analysis Of The Residual Tumor In ReTUR

Objective:Many patients with non-muscle invasive bladder cancer (NMIBC) suffer recurrence and progression after routine surgical treatment. The clinical use of reTUR has improved the prognosis of NMIBC patients. However, it is still lack of sufficient clinical data in our courtry. This study aimed to explore the use of reTUR treatment in our center and its impact on prognosis.Methods:Retrospective collected (from2008to2013) data of NMIBC patients that meet the included indications. K-M survival curves and multivariate COX proportional hazard model are uesd to determine the impact of the reTUR on prognosis of patients.Results:A total of81patients received a single TUR,36patients underwent reTUR were included in our study. In reTUR group, the residual tumor rate was44.4%(16/36). Two years after surgery,54%of patients in single TUR group suffered recurrence, while only36%of patients accepting reRUR recurrenced (p<0.05). Two years after surgery the progression rate of of bladder cancer patients in single TUR group is25%, while only11%bladder cancer patients who accepted ReRUR suffered disease progression (p=0.157). In multivariate analysis, reTUR was independent predictor of recurrence-free survival (HR=0.35,95% CI=0.17-0.71, p=0.003), the impact of reTUR on progression-free survival was not statistically significant (HR=0.51,95%CI=0.17-1.51, p=0.22).Conclusion:ReTUR reduces the recurrence of bladder cancer. Although not statistically significant, reTUR may affect disease progression after surgery, but the exact impact remains to be further confirmed.Chapter2the risk analysis of the residual tumor in reTUObjective:NMIBC is a kind of tumors with high heterogeneity. Although reTUR can significantly improve the prognosis of patients with bladder cancer, but not all the patients who meet the reTUR indications have residual tumor after the first TUR, and really benefit from reTUR Therefore, we have designed this section and attempt to explore whether other clinical, molecular markers are able to play a role in guiding reTUR.Methods:Retrospective collected (from2008to2013) data of NMIBC patients who received reTUR, and expression of P53, Ki67, VEGF, E-cadherin and survivin in first TUR specimens of all patients tumor were measured by immunohistochemistry. Multivariate logistic analysis was used to build residual tumor risk equation. Then, residual tumor risk scoring model based was build by risk equation regression coefficients.Results:The risk equation of residual tumors:logitP=-1.85+2.29X1+1.21X2+1.28X3(X1as tumor size, X2as p53, X3is E-cadherin). Risk model of residual tumor was successfully established, residual tumor rates in low-risk group, moderate-risk group and high-risk group were9.1%,27.3%,85.7%, respectively. Sensitivity and specificity of low-high risk classification (93.8%,50%) is superior than classification by tumor size (50%,90%), p53(50%,75%)or E-cadherin (62.5,75%) alone.Conclusion:Tumor size, p53, E-cadherin are independent risk factors of residual tumor after TUR. By building scoring models, patients can be divided into low-risk group, moderate-risk group, high-risk group, which better predict the risk of postoperative residual tumors. The use of risk model is significantly superior than classification by single risk factor to evaluate of residual tumor. For patients in high-risk groups, reTUR is strongly recommended, for low-risk populations, reTUR should be considered carefully.