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Organo Oficial de la Sociedad Mexicana de Urología

2023, Number 1

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Rev Mex Urol 2023; 83 (1)

Development of a predictive model for optimizing the selection of patients for second transurethral resection bladder

Moreno-Cortés José-Carlos, Caño-Velasco J, Quintana-Álvarez R, Aragón-Chamizo J, Gonzalez-de-Gor-García-Herra V, Sánchez-Ochoa María-Alejandra, Durán-Merino R, Herranz-Amo F, Hernández-Fernández C

Language: English
References: 17
Page:
PDF size: 257.22 Kb.


ABSTRACT

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 seçcond-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

  1. Rouprêt M, Babjuk M, Böhle A, Burger M,Compérat E, Cowan N, et al. Upper UrinaryTract Urothelial Carcinoma. Non-muscleinvasiveBladder Cancer (TaT1 and CIS).Guidelines. 2021 Apr 1. [accessed 21 Feb 2023] Available from: https://bladder.uroonco.uroweb.org/guideline/upper-urinary-tracturothelial-cell-carcinoma/

  2. Cumberbatch MGK, Foerster B, Catto JWF,Kamat AM, Kassouf W, Jubber I, et al. RepeatTransurethral Resection in Non-muscle-invasiveBladder Cancer: A Systematic Review. EurUrol. 2018 Jun;73(6):925–33. doi: 10.1016/j.eururo.2018.02.014

  3. Naselli A, Hurle R, Paparella S, Buffi NM,Lughezzani G, Lista G, et al. Role of RestagingTransurethral Resection for T1 Non-muscleinvasive Bladder Cancer: A Systematic Reviewand Meta-analysis. Eur Urol Focus. 2018Jul;4(4):558–67. doi: 10.1016/j.euf.2016.12.011

  4. Chang SS, Boorjian SA, Chou R, Clark PE,Daneshmand S, Konety BR, et al. Diagnosisand Treatment of Non-Muscle InvasiveBladder Cancer: AUA/SUO Guideline. J Urol.2016 Oct;196(4):1021–9. doi: 10.1016/j.juro.2016.06.049

  5. Bansal A, Sankhwar S, Goel A, Kumar M,Purkait B, Aeron R. Grading of complications oftransurethral resection of bladder tumor usingClavien-Dindo classification system. Indian JUrol. 2016;32(3):232–7. doi: 10.4103/0970-1591.185104

  6. Brierley JD, Gospodarowicz MK, WittekindC, editors. TNM Classification of MalignantTumours, 8th edition | UICC. 8th ed. Ginebra:Union for International Cancer Control/Wiley Publications; 2016. [accessed 21 Feb2023] Available from: https://www.uicc.org/resources/tnm-classification-malignanttumours-8th-edition

  7. Sylvester RJ, van der Meijden APM,Oosterlinck W, Witjes JA, Bouffioux C,Denis L, et al. Predicting recurrence andprogression in individual patients with stage TaT1 bladder cancer using EORTC risk tables: acombined analysis of 2596 patients from sevenEORTC trials. Eur Urol. 2006 Mar;49(3):466–465; discussion 475-477. doi: 10.1016/j.eururo.2005.12.031

  8. Gendy R, Delprado W, Brenner P, Brooks A,Coombes G, Cozzi P, et al. Repeat transurethralresection for non-muscle-invasive bladdercancer: a contemporary series. BJU Int. 2016Apr;117 Suppl 4:54–9. doi: 10.1111/bju.13265

  9. Dobruch J, Borówka A, Herr HW. Clinicalvalue of transurethral second resection ofbladder tumor: systematic review. Urology.2014 Oct;84(4):881–5. doi: 10.1016/j.urology.2014.06.005

  10. Chamlati-Cuello JM, Garza-GangemiAM, Gonzaga-Carlos N, Iturriaga-GoyónE, Castillejos-Molina RA. Second-lookhistopathologic results in non-muscle-invasiveurothelial carcinoma of the bladder: Is repeatresection necessary? Rev Mex Urol. 2017 Jul17;77(3):183–90.

  11. Rosales Fajardo L, Santana Sarrhy LS, CintaAlejo y Dreyde R. Resultados de la re-RTU enel tumor de vejiga no musculo- invasivo de altogrado. Revista Cubana de Urología. 2014 Jan28;2(2). [accessed 21 Feb 2023] Available from:https://revurologia.sld.cu/index.php/rcu/article/view/189

  12. Akand M, Muilwijk T, Raskin Y, De VriezeM, Joniau S, Van Der Aa F. Quality ControlIndicators for Transurethral Resection ofNon–Muscle-Invasive Bladder Cancer. ClinicalGenitourinary Cancer. 2019 Aug 1;17(4):e784–92. doi: 10.1016/j.clgc.2019.04.014

  13. Pisano F, Gontero P, Sylvester R, JoniauS, Serretta V, Larré S, et al. Factores deriesgo de enfermedad residual en la re-RTU en una gran cohorte de pacientes conenfermedad T1G3. Actas Urológicas Españolas.2021 Jul 1;45(6):473–8. doi: 10.1016/j.acuro.2020.08.016

  14. Gontero P, Sylvester R, Pisano F, Joniau S,Oderda M, Serretta V, et al. The impact of retransurethralresection on clinical outcomesin a large multicentre cohort of patients withT1 high-grade/Grade 3 bladder cancer treatedwith bacille Calmette-Guérin. BJU Int. 2016Jul;118(1):44–52. doi: 10.1111/bju.13354

  15. Akitake M, Yamaguchi A, Shiota M,Imada K, Tatsugami K, Yokomizo A, et al.Predictive Factors for Residual Cancer inSecond Transurethral Resection for Nonmuscle-invasive Bladder Cancer. AnticancerRes. 2019 Aug;39(8):4325–8. doi: 10.21873/anticanres.13598

  16. Divrik RT, Yildirim U, Zorlu F, Ozen H. The effectof repeat transurethral resection on recurrenceand progression rates in patients with T1tumors of the bladder who received intravesicalmitomycin: a prospective, randomized clinicaltrial. J Urol. 2006 May;175(5):1641–4. doi:10.1016/S0022-5347(05)01002-5

  17. Ferro M, Di Lorenzo G, Buonerba C, LucarelliG, Russo GI, Cantiello F, et al. Predictors ofResidual T1 High Grade on Re-TransurethralResection in a Large Multi-Institutional Cohortof Patients with Primary T1 High-Grade/Grade3 Bladder Cancer. J Cancer. 2018;9(22):4250–4.doi: 10.7150/jca.26129




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