比較T1膀胱癌有無做第二次膀胱腫瘤切除術後的長期療效 — 單一醫學中心五年的經驗
曾文歆、廖建華、沈坤宏、黃冠華1、陳俊豪、洪順興2、劉建良、蘇家震、王致丞、李高漢、李健逢3
奇美醫學中心 外科部 泌尿外科，1泌尿腫瘤科；
2佳里奇美醫院 外科部 泌尿外科；
3奇美醫學中心 病理科
Comparison of long-term outcome of patients regarding the efficacy of second-look transurethral resection of bladder tumor for T1 bladder cancer: A five-year experience in a single center
Wen-Hsin Tseng、Alex Chien-Hwa Liao、Kun-Hung Shen、Steven K. Huang1、Chun-Hao Chen、 Shun-Hsing Hung2、Chien-Liang Liu、Chia-Cheng Su、Jhih-Cheng Wang、Kau-Han Lee、 Chien-Feng Li3
Division of Urology, Department of Surgery; 1Division of Uro-Oncology, Chi Mei Medical Center, Tainan, Taiwan;
2Division of Urology, Department of Surgery, Chi Mei Hospital, Chiali, Tainan, Taiwan
3Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
Purpose:
Transurethral resection of bladder tumor (TURBT) is not only a treatment tool, but it also has a very important role in determining cancer staging. In recent years, second-look TURBT has been recommended to be performed in patients with a high recurrence risk and diagnosed with T1 bladder cancer after initial TURBT. Therefore, the aim of this study is to compare the differences in the long-term outcome between patients who accepted and those who did not accept second-look TURBT for T1 bladder cancer.
Materials and Methods:
This study enrolled a total of 504 patients who were pathologically diagnosed with urothelial carcinoma and underwent initial TURBT between January 2012 and December 2016, and a total of 240 patients were diagnosed with T1 urothelial carcinoma in the bladder. Then 55 patients were excluded for showing recurrence or the tumor was not only in bladder but also found in upper urinary tract or prostatic urethra or no
muscularis propria in the initial TURBT. Second-look TURBT was performed within 4–14 weeks after the initial TURBT for the patients in group 1, but not for those in group 2. We followed up the recurrence-free survival and progression-free survival between the two groups and analyzed their risk factors for recurrence and progression.
Results:
In this study, a total of 101 (55%) patients underwent second-look TURBT in groups 1, and 84 (45%) patients did not undergo second-look TURBT in group2. In group 1, 18 (18%) patients had residual tumors based on the pathological report, 1 had pTa, 7 had carcinoma in situ, 9 had pT1, and 1 had pT2 disease. The 5-year recurrence-free survival rates were 60.4% and 51.6%, and the progression-free survival rates were 82.2% and 78% in groups 1 and 2, respectively.
Conclusion:
This study demonstrated relatively higher recurrence-free and progression-free survival rates in patients who underwent second-look TURBT and those did not for T1 bladder urothelial carcinoma. This result emphasizes the important role of second-look TURBT in T1 bladder cancer.