Comparison of transurethral en-bloc resection and transurethral resection of bladder tumor for the treatment of high-risk non-muscle-invasive bladder cancer

doi:10.3877/cma.j.issn.1674-3253.2025.03.005

Abstract

Abstract:

Objective

To compare the clinical efficacy of en-bloc resection of bladder tumor（ERBT） with transurethral resection of bladder tumor （TURBT） in the comprehensive preservation of bladder treatment for high-risk non-muscle-invasive bladder cancer （NMIBC） patients.

Methods

A retrospective analysis was conducted on the data of 104 patients with high-risk NMIBC from November 2016 to September 2022 in the First Affiliated Hospital， Sun Yat-sen University.Among them，62 patients received ERBT and 42 patients received TURBT.The recurrence-free survival （RFS），recurrence rate， progression rate， and bladder preservation rate were compared between the two groups.

Results

There was no significant difference in demographic data between the two groups （P＞0.05）.The median recurrence-free survival was 30（20， 49） months in the ERBT group and 19（9， 49） months in the TURBT group.The recurrence rate was 16.1% in the ERBT group and 57.1% in the TURBT group.The progression rate was 4.8% in the ERBT group and 9.5% in the TURBT group.The bladder preservation rate was 96.8% in the ERBT group and 95.2% in the TURBT group.There were statistically significant differences in recurrence-free survival time and recurrence rate between the two groups（P＜0.05）.However， no significant difference was observed in progression rate between the groups（P＞0.05）.

Conclusion

Patients in the ERBT group had a lower recurrence rate and longer recurrencefree survival compared with those in the TURBT group.ERBT has more advantages than TURBT in bladder-preserving treatment of high-risk NMIBC patients.

Key words: Bladder cancer, En bloc resection of bladder tumor, Bladder sparing, Holmium laser, Recurrence-free survival (RFS)

Wenhao Zhan, Ren Liu, Xiaolan Zeng, Junxing Chen, Zongren Wang. Comparison of transurethral en-bloc resection and transurethral resection of bladder tumor for the treatment of high-risk non-muscle-invasive bladder cancer[J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(03): 309-314.

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References 26

［1］	Siegel RL， Miller KD， Jemal A.Cancer statistics， 2020［J］.CA A Cancer J Clinicians， 2020， 70（1）： 7-30.DOI： 10.3322/caac.21590.
［2］	孙可欣，郑荣寿，张思维，等.2015 年中国分地区恶性肿瘤发病和死亡分析［J］.中国肿瘤， 2019， 28（1）： 1-11.DOI： 10.11735/j.issn.1004-0242.2019.01.A001.Sun KX， Zheng RS， Zhang SW， et al.Report of cancer incidence and mortality in different areas of China， 2015［J］.China Cancer， 2019，28（1）： 1-11.DOI： 10.11735/j.issn.1004-0242.2019.01.A001.
［3］	Flaig TW， Spiess PE， Agarwal N， et al.Bladder cancer， version 3.2020， NCCN clinical practice guidelines in oncology［J］.J Natl Compr Canc Netw， 2020， 18（3）： 329-354.DOI： 10.6004/jnccn.2020.0011.
［4］	Wood DP.Re： final results of an EORTC-GU cancers group randomized study of maintenance Bacillus calmette-guérin in intermediate- and high-risk T_a， T₁ papillary carcinoma of the urinary bladder： one-third dose versus full dose and 1 year versus 3 years of maintenance［J］.J Urol， 2014， 191（2）： 348-349.DOI： 10.1016/j.juro.2013.10.133.
［5］	Babjuk M， Burger M， Capoun O， et al.European association of urology guidelines on non-muscle-invasive bladder cancer （T_a，T₁， and carcinoma in situ）［J］.Eur Urol， 2022， 81（1）： 75-94.DOI：10.1016/j.eururo.2021.08.010.
［6］	Kesavan A， Esuvaranathan K.Re： pembrolizumab monotherapy for the treatment of high-risk non-muscle-invasive bladder cancer unresponsive to BCG （KEYNOTE-057）： an open-label， single-arm，multicentre， phase 2 study［J］.Eur Urol， 2021， 80（5）： 671.DOI：10.1016/j.eururo.2021.07.020.
［7］	Kulkarni GS， Wettstein MS.SWOG S1605： moving beyond systemic immune checkpoint inhibitor monotherapy in Bacillus calmetteguérin-unresponsive non-muscle-invasive bladder cancer［J］.Eur Urol， 2023， 84（6）： 545-546.DOI： 10.1016/j.eururo.2023.09.013.
［8］	Kramer MW， Bach T， Wolters M， et al.Current evidence for transurethral laser therapy of non-muscle invasive bladder cancer［J］.World J Urol， 2011， 29（4）： 433-442.DOI： 10.1007/s00345-011-0680-5.
［9］	沈鹏，欧彤文，许建军，等.经尿道2 μm 激光与电切治疗表浅性膀胱肿瘤的临床疗效比较［J］.现代泌尿外科杂志， 2011， 16（5）：417-418， 421.DOI： 10.3969/j.issn.1009-8291.2011.05.011.Shen P， Ou TW， Xu JJ， et al.Clinical comparative study of 2μm continuous wave laser resection and transurethral resection for superficial bladder tumor［J］.J Mod Urol， 2011， 16（5）： 417-418， 421.DOI： 10.3969/j.issn.1009-8291.2011.05.011.
［10］	魏海彬，孙晓文.铥激光在泌尿外科中的应用及进展［J］.现代生物医学进展， 2012， 12（35）： 6975-6977， 6939.DOI： 10.13241/j.cnki.pmb.2012.35.019.Wei HB， Sun XW.The application and progress of thulium laser in urology［J］.Prog Mod Biomed， 2012， 12（35）： 6975-6977， 6939.DOI：10.13241/j.cnki.pmb.2012.35.019.
［11］	梁耿祺，关礼贤，廖俊发，等.1 470 nm 激光膀胱肿瘤整块切除与传统电切治疗非肌层浸润性膀胱癌的比较［J/OL］.中华腔镜泌尿外科杂志（电子版）， 2023， 17（3）： 257-260.DOI： 10.3877/cma.j.issn.1674-3253.2023.03.012.Liang GQ， Guan LX， Liao JF， et al.A control study of the safety and efficacy of 1 470 nm laser en bloc resection of bladder tumor versus transurethral resection of bladder tumor in the treatment of non-muscular invasive bladder cancer［J/OL］.Chin J Endourol Electron Ed， 2023， 17（3）： 257-260.DOI： 10.3877/cma.j.issn.1674-3253.2023.03.012.
［12］	Liu H， Wu J， Xue S， et al.Comparison of the safety and efficacy of conventional monopolar and 2-micron laser transurethral resection in the management of multiple nonmuscle-invasive bladder cancer［J］.J Int Med Res， 2013， 41（4）： 984-992.DOI：10.1177/0300060513477001.
［13］	Hashem A， Mosbah A， El-Tabey NA， et al.Holmium laser en-bloc resection versus conventional transurethral resection of bladder tumors for treatment of non-muscle-invasive bladder cancer： a randomized clinical trial［J］.Eur Urol Focus， 2021， 7（5）： 1035-1043.DOI： 10.1016/j.euf.2020.12.003.
［14］	Yanagisawa T， Miki J， Yorozu T， et al.Vertical Lamina propria invasion diagnosed by en bloc transurethral resection is a significant predictor of progression for PT1 bladder cancer［J］.J Urol， 2021，205（6）： 1622-1628.DOI： 10.1097/ju.0000000000001630.
［15］	Fan J， Zhang X， Fan J， et al.Risk stratification for the rate and location of residual bladder tumor for the decision of re-transurethral resection of bladder tumor［J］.Front Oncol， 2022， 12： 788568.DOI：10.3389/fonc.2022.788568.
［16］	Nicoletti R， Gauhar V， Castellani D， et al.Current techniques for en bloc transurethral resection of bladder tumor： a hands-on guide through the energy landscape［J］.Eur Urol Focus， 2023， 9（4）： 567-570.DOI： 10.1016/j.euf.2023.04.007.
［17］	Li Z， Zhou Z， Cui Y， et al.Systematic review and meta-analysis of randomized controlled trials of perioperative outcomes and prognosis of transurethral en-bloc resection vs.conventional transurethral resection for non-muscle-invasive bladder cancer［J］.Int J Surg， 2022，104： 106777.DOI： 10.1016/j.ijsu.2022.106777.
［18］	Sari Motlagh R， Rajwa P， Mori K， et al.Comparison of clinicopathologic and oncological outcomes between transurethral en bloc resection and conventional transurethral resection of bladder tumor： a systematic review， meta-analysis， and network meta-analysis with focus on different energy sources［J］.J Endourol， 2022， 36（4）：535-547.DOI： 10.1089/end.2021.0688.
［19］	钟辛，李方，李冠奕，等.经尿道铥激光整块切除术与电切术治疗非肌层浸润性膀胱肿瘤疗效对比［J］.中国老年学杂志， 2022，42（6）： 1330-1333.DOI： 10.3969/j.issn.1005-9202.2022.06.015.Zhong X， Li F， Li GY， et al.Comparison of efficacy between thulium laser en bloc resection and transurethral resection for non-muscle invasive bladder tumor［J］.Chin J Gerontol， 2022， 42（6）： 1330-1333.DOI： 10.3969/j.issn.1005-9202.2022.06.015.
［20］	王毓斌，吕永安，邵晋凯，等.2 μm 激光膀胱肿瘤切除术与经尿道膀胱肿瘤电切术治疗非肌层浸润性膀胱肿瘤的疗效比较［J］.肿瘤研究与临床， 2012， 24（5）： 321-323.DOI： 10.3760/cma.j.issn.1006-9801.2012.05.012.Wang YB， Lyu YA， Shao JK， et al.Comparison of 2 μm continuouswave laser resection and transurethral resection of bladder tumor for nonmuscle-invasive bladder tumor［J］.Cancer Res Clin， 2012， 24（5）：321-323.DOI： 10.3760/cma.j.issn.1006-9801.2012.05.012.
［21］	Iscaife A， Filho LAR， Pereira MWA， et al.Holmium laser resection of large bladder tumors： technique description， feasibility， and histopathological quality analysis［J］.Urology， 2022， 165： 373.DOI：10.1016/j.urology.2022.04.021.
［22］	Yang Y， Liu C， Yang X， et al.Transurethral en bloc resection with monopolar current for non-muscle invasive bladder cancer based on TNM system［J］.Transl Cancer Res， 2020， 9（4）： 2210-2219.DOI：10.21037/tcr.2020.03.48.
［23］	Croghan SM， Compton N， Manecksha RP， et al.En bloc transurethral resection of bladder tumors： a review of current techniques［J］.Can Urol Assoc J， 2022， 16（5）： E287-E293.DOI： 10.5489/cuaj.7539.
［24］	Enikeev D， Babjuk M， Shpikina A， et al.En bloc resection for nonmuscle-invasive bladder cancer： selecting a proper laser［J］.Curr Opin Urol， 2022， 32（2）： 173-178.DOI： 10.1097/MOU.0000000000000968.
［25］	Yanagisawa T， Mori K， Motlagh RS， et al.En bloc resection for bladder tumors： an updated systematic review and meta-analysis of its differential effect on safety， recurrence and histopathology［J］.J Urol， 2022， 207（4）： 754-768.DOI： 10.1097/JU.0000000000002444.
［26］	Enikeev D， Morozov A， Shpikina A， et al.A 10-year renaissance of en bloc resection of bladder tumors （ERBT）： Are we approaching the peak or is it back to the trough?［J］.World J Urol， 2023， 41（10）： 2607-2615.DOI： 10.1007/s00345-023-04439-3.

组别	例数	性别（例）		年龄（例）		BMI［kg/m²，M（Q）］	吸烟者［例（%）］	BCG灌注次数［M（Q）］	肿瘤数量（例）		`肿瘤大小（例）
组别	例数	男	女	＞60	≤60	BMI［kg/m²，M（Q）］	吸烟者［例（%）］	BCG灌注次数［M（Q）］	单发	多发	＞3.0 cm	≤3.0 cm
ERBT组	62	51	11	40	22	23.0（20.8，25.0）	17（27.4）	18（16，19）	33	29	21	41
TURBT组	42	37	5	22	20	23.8（22.0，26.1）	10（23.8）	18（17，19）	20	22	8	34
统计值		χ ²=0.655		χ ²=1.532		Z=-1.895	χ ²=0.170	Z=-0.393	χ ²=0.315		χ ²=2.736
P值		0.418		0.216		0.058	0.680	0.694	0.575		0.098
组别	病理级别（例）		T分期（例）		复发率［例（%）］	无复发生存时间［月，M（Q）］	随访时间［月，M（Q）］	保膀胱率［例（%）］	进展率［例（%）］
组别	低级别	高级别	Ta	T1	复发率［例（%）］	无复发生存时间［月，M（Q）］	随访时间［月，M（Q）］	保膀胱率［例（%）］	进展率［例（%）］
ERBT组	15	47	6	56	10（16.1）	30（20，49）	35（22，51）	60（96.8）	3（4.8）
TURBT组	10	32	6	36	24（57.1）	19（9，46）	52（39，66）	40（95.2）	4（9.5）
统计值	χ ²=0.002		χ ²=0.521		χ ²=19.141	Z=-2.269	Z=-2.716	χ ²=0.160	χ ²=0.875
P值	0.964		0.470		＜0.001	0.023	0.007	0.689	0.349

组别	例数	性别（例）		年龄（例）		BMI［kg/m²，M（Q）］	吸烟者［例（%）］	BCG灌注次数［M（Q）］	肿瘤数量（例）		`肿瘤大小（例）
组别	例数	男	女	＞60	≤60	BMI［kg/m²，M（Q）］	吸烟者［例（%）］	BCG灌注次数［M（Q）］	单发	多发	＞3.0 cm	≤3.0 cm
ERBT组	62	51	11	40	22	23.0（20.8，25.0）	17（27.4）	18（16，19）	33	29	21	41
TURBT组	42	37	5	22	20	23.8（22.0，26.1）	10（23.8）	18（17，19）	20	22	8	34
统计值		χ ²=0.655		χ ²=1.532		Z=-1.895	χ ²=0.170	Z=-0.393	χ ²=0.315		χ ²=2.736
P值		0.418		0.216		0.058	0.680	0.694	0.575		0.098
组别	病理级别（例）		T分期（例）		复发率［例（%）］	无复发生存时间［月，M（Q）］	随访时间［月，M（Q）］	保膀胱率［例（%）］	进展率［例（%）］
组别	低级别	高级别	Ta	T1	复发率［例（%）］	无复发生存时间［月，M（Q）］	随访时间［月，M（Q）］	保膀胱率［例（%）］	进展率［例（%）］
ERBT组	15	47	6	56	10（16.1）	30（20，49）	35（22，51）	60（96.8）	3（4.8）
TURBT组	10	32	6	36	24（57.1）	19（9，46）	52（39，66）	40（95.2）	4（9.5）
统计值	χ ²=0.002		χ ²=0.521		χ ²=19.141	Z=-2.269	Z=-2.716	χ ²=0.160	χ ²=0.875
P值	0.964		0.470		＜0.001	0.023	0.007	0.689	0.349

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