Significance of second transurethral resection in stage T2 bladder carcinoma patients treated with bladder-preserving therapy

doi:10.3877/cma.j.issn.1674-3253.2021.04.013

Abstract

Abstract:

Objective

To investigate the clinical significance and safety of second transurethral resection for patients with stage T2 bladder carcinoma treated with bladder-preservation-therapy(BPT) protocal.

Methods

The clinical data of 71 patients with stage T2 muscle-invasive bladder carcinoma treated with BPT in People’s Hospital of Huaibei city between June 2013 and June 2020 were analyzed retrospectively. The patients were evaluated by CT/MRI and confirmed as stage T2 bladder carcinoma by biospy after surgery. All of them were medically unfit or refused radical surgery. Among them, 33 patients underwent secondary transurethral resection of bladder cancer (TURBT) after initial resetion, the others didn't underwent secondary TURBT. After TURBT with or without secondary TURBT, patients received chemotherapy of gemcitabine plus cisplatin (GC) and bladder perfusion according to oncologist’s consultion. The relationship of secondary TURBT and disease-free survival (DFS) was analyzed to illustrate the clinical value of secondary TURBT in BPT protocal of stage T2 bladder carcinoma.

Results

There was no significant difference in operation time, hospitalization days, blood loss or postoperative complications between two groups. Kaplan-Meier analysis showed that the mean DFS of secondary TURBT group was 60.6 months, while the other group was 47.2 months. The differences were statistically significant.Cox proportion-hazards regression modal analysis incidated that the secondary TURBT was an independent prognostic factor for stage T2 bladder carcinoma.

Conclusion

Secondary TURBT might alleviate the incidence of recurrence and progression of stage T2 bladder carcinoma patients underwent BPT protocal, compared to single TURBT, which can provide an effective and safe treatment option for patients.

Key words: Bladder carcinoma, Therapy protocal, Bladder resection, Disease-free survival

Lingqiu Chen, Peng Wang, Longping Yuan, Congliang Yi. Significance of second transurethral resection in stage T2 bladder carcinoma patients treated with bladder-preserving therapy[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(04): 325-329.

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References 21

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组别	例数	性别(例)		年龄[岁，M(Q)]	肿瘤直径[cm，M(Q)]	肿瘤数目(例)		肿瘤病理分级(例)
组别	例数	男	女	年龄[岁，M(Q)]	肿瘤直径[cm，M(Q)]	单发	多发	低级别	高级别
二次电切组	33	28	5	78(88,43)	3.0(4.0,1.0)	21	12	13	20
单次电切组	38	25	13	74(86,22)	2.5(5.2,1.0)	20	18	18	20
统计值		χ²=3.39		Z=-0.104	Z=-0.317	χ²=8.77		χ²=1.85
P值		0.066		0.917	0.752	0.349		0.174
组别	手术时间[min，M(Q)]	术后血红蛋白下降值[g/L，(±s)]	住院天数[d，(±s)]	术后血尿(例)		术后感染(例)		复发(例)
组别	手术时间[min，M(Q)]	术后血红蛋白下降值[g/L，(±s)]	住院天数[d，(±s)]	有	无	有	无	是	否
二次电切组	50(15,150)	12.3±2.3	12.4±4.4	2	31	4	29	2	31
单次电切组	42.5(10,115)	8.9±0.8	11.4±2.7	1	37	3	35	14	24
统计值	Z=0.59	t=1.40	t=1.09	-	-	-	-	9.586
P值	0.550	0.158	0.279	0.594		0.697		0.002

组别	例数	性别(例)		年龄[岁，M(Q)]	肿瘤直径[cm，M(Q)]	肿瘤数目(例)		肿瘤病理分级(例)
组别	例数	男	女	年龄[岁，M(Q)]	肿瘤直径[cm，M(Q)]	单发	多发	低级别	高级别
二次电切组	33	28	5	78(88,43)	3.0(4.0,1.0)	21	12	13	20
单次电切组	38	25	13	74(86,22)	2.5(5.2,1.0)	20	18	18	20
统计值		χ²=3.39		Z=-0.104	Z=-0.317	χ²=8.77		χ²=1.85
P值		0.066		0.917	0.752	0.349		0.174
组别	手术时间[min，M(Q)]	术后血红蛋白下降值[g/L，(±s)]	住院天数[d，(±s)]	术后血尿(例)		术后感染(例)		复发(例)
组别	手术时间[min，M(Q)]	术后血红蛋白下降值[g/L，(±s)]	住院天数[d，(±s)]	有	无	有	无	是	否
二次电切组	50(15,150)	12.3±2.3	12.4±4.4	2	31	4	29	2	31
单次电切组	42.5(10,115)	8.9±0.8	11.4±2.7	1	37	3	35	14	24
统计值	Z=0.59	t=1.40	t=1.09	-	-	-	-	9.586
P值	0.550	0.158	0.279	0.594		0.697		0.002

变量	多因素分析
变量	Wald	P值	Exp(B)	95%CI
年龄	0.104	0.747	1.008	0.958～1.061
性别	0.993	0.319	1.748	0.583～5.245
病理分期(高/低级别)	0.732	0.395	0.607	0.192～1.917
肿瘤数量(多/单发)	0.235	0.628	1.460	0.316～6.745
肿瘤直径(>3cm/≤3 cm)	1.043	0.307	1.846	0.569～5.985
电切(二次/单次)	5.893	0.015	0.033	0.695

变量	多因素分析
变量	Wald	P值	Exp(B)	95%CI
年龄	0.104	0.747	1.008	0.958～1.061
性别	0.993	0.319	1.748	0.583～5.245
病理分期(高/低级别)	0.732	0.395	0.607	0.192～1.917
肿瘤数量(多/单发)	0.235	0.628	1.460	0.316～6.745
肿瘤直径(>3cm/≤3 cm)	1.043	0.307	1.846	0.569～5.985
电切(二次/单次)	5.893	0.015	0.033	0.695

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