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When to Avoid a Restaging Procedure for Non-muscle Invasive Bladder Cancer? Inferences from a Tertiary Care Center

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Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

The increasing incidence of urinary bladder carcinoma is alarming. Approximately seventy percent of these patients are non-muscle invasive bladder cancer (NMIBC). Restage transurethral resection of bladder tumor (TURBT) is the current recommendation for any T1 and or high-grade non muscle invasive bladder cancers (NMIBC) to accurately stage the malignancy. The question whether a second surgery is always required as a restage procedure is still unanswered. The patient’s concern about completeness, morbidity, and financial considerations of a major surgery cannot be overlooked. Moreover, it also puts a strain on the already overburdened healthcare system. To answer this question, whether it is oncologically sound to omit a second resection, the current study evaluated the outcomes of patients undergoing restage TURBT, and analyzed the preoperative factors predicting a change in the staging of this malignancy. The study design was a prospective observational including NMIBC patients from September 2018 to February 2020. A total of 72 patients underwent restage TURBT. Their demographic data, imaging and cystoscopic findings, and histopathological data were recorded. The objective was to study the clinico-pathological correlations and factors predicting recurrence and upstaging of tumor in NMIBC patients undergoing restage TURBT. A total of 101 patients were found eligible for restage TURBT. Eventually, 72 underwent restage TURBT. Twelve (16.7%) patient had recurrence at restage while 3(4.16%) were upstaged to T2. Presence of lower urinary tract symptoms (LUTS) was independently associated with the risk of recurrence of same stage compared to no recurrence (p-0.025, OR-8.793, 95% CI-1.316–98.773). Chemical exposure (p-0.042) was also significantly associated with the same. Presence of lymphadenopathy on CT was independently associated with the risk of upstaging compared to no recurrence (p-0.032, OR-18.25, 95% CI-1.292–257.85). The study concluded that in the presence of a well-performed and adequate initial TURBT, restage TURBT could be skipped for further management. However, in small subgroup of patients with lymphadenopathy on preoperative imaging having a higher risk of tumor recurrence and upstaging, and patients with a history of chemical exposure and previous lower urinary tract symptoms having a high risk of recurrence alone, restage TURBT should still be performed to accurately stage the disease. Further studies with large patient cohort are needed to confirm and reinforce the facts proposed.

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References

  1. Richters A, Aben KKH, Kiemeney LALM (2020) The global burden of urinary bladder cancer: an update. World J Urol. 38(8):1895–1904. https://doi.org/10.1007/s00345-019-02984-4

    Article  PubMed  Google Scholar 

  2. Isharwal S, Konety B (2015) Non-muscle invasive bladder cancer risk stratification. Indian J Urol 31(4):289–296

    Article  Google Scholar 

  3. Yuvaraja TB, Ganesh SW, Bakshi GP (2016) Genitourinary cancers: summary of Indian data. South Asian J Cancer 5(3):122–4

    Article  CAS  Google Scholar 

  4. Woldu SL, Bagrodia A, Lotan Y (2017) Guideline of guidelines: non-muscle-invasive bladder cancer. BJU Int 119(3):371–380

    Article  Google Scholar 

  5. Gontero P, Sylvester R, Pisano F, Joniau S, Oderda M, Serretta V et al (2016) The impact of re-transurethral resection on clinical outcomes in a large multicentre cohort of patients with T1 high-grade/Grade 3 bladder cancer treated with bacille Calmette-Guérin. BJU Int 118(1):44–52

    Article  Google Scholar 

  6. Tobert CM, Nepple KG, McDowell BD, Charlton ME, Mott SL, Gruca TS et al (2019 Oct) Compliance With American Urological Association Guidelines for Nonmuscle Invasive Bladder Cancer Remains Poor: Assessing Factors Associated With Noncompliance and Survival in a Rural State. Urology. 132:150–155. https://doi.org/10.1016/j.urology.2019.06.021

  7. Gotto GT, Shea- Budgell MA, Dean Ruether J (2016) Low compliance with guidelines for re-staging in high-grade T1 bladder cancer and the potential impact on patient outcomes in the province of Alberta. Can Urol Assoc J 10(1–2):33–8. https://doi.org/10.5489/cuaj.3143

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tseng WH, Liao A, Shen KH, Chen CH, Liu CL, Hung SH et al (2018) Role of second-look transurethral resection of bladder tumors for newly diagnosed T1 bladder cancer: experience at a single center. Urol Sci 29(2):95–99

    Article  Google Scholar 

  9. Dwivedi US, Kumar A, Das SK, Trivedi S, Kumar M, Sunder S et al (2009) Relook TURBT in superficial bladder cancer: its importance and its correlation with the tumor ploidy. Urol Oncol 5:514–9. https://doi.org/10.1016/j.urolonc.2008.04.015

    Article  Google Scholar 

  10. Rolevich A, Minich A, Nabebina T, Polyakov S, Krasny S, Sukonko O (2016) Surgeon has a major impact on long-term recurrence risk in patients with non-muscle invasive bladder cancer. Cent Eur J Urol 69(2):170–177

    Google Scholar 

  11. Herr HW, Donat SM (2008) Quality control in transurethral resection of bladder tumours. BJU Int 102(9B):1242–1246

    Article  Google Scholar 

  12. Atta MA, Kotb AF, Sharafeldeen M, Elabbady A, Hashad MM. The value of extended good quality transurethral resection of bladder tumour in the treatment of the newly diagnosed bladder cancer. Arab J Urol [Internet]. 2017;15(1):60–3. Available from:https://doi.org/10.1016/j.aju.2016.10.003

  13. Mariappan P, Finney SM, Head E, Somani BK, Zachou A, Smith G et al (2012) Good quality white-light transurethral resection of bladder tumours (GQ-WLTURBT) with experienced surgeons performing complete resections and obtaining detrusor muscle reduces early recurrence in new non-muscle-invasive bladder cancer: Validation across t. BJU Int 109(11):1666–1673

    Article  Google Scholar 

  14. Divrik RT, Yildirim U, Zorlu FOH (2006) The effect of repeat transurethral resection on recurrence and progression rates in patients with T1 tumors of the bladder who received intravesical mitomycin: a prospective, randomized clinical trial. J Urol 175(5):1641–1644

    Article  CAS  Google Scholar 

  15. Manoharan V, Mavuduru RS, Kumar S, Kakkar N, Devana SK, Bora GS, Singh SKMA (2018) Utility of restage transurethral resection of bladder tumor. Indian J Urol 34(4):273–277

    Article  Google Scholar 

  16. Katumalla FS, Devasia A, Kumar R, Kumar S, Chacko N, Kekre N (2011) Second transurethral resection in T1G3 bladder tumors-selectively avoidable. Indian J Urol 27(2):176–179

    Article  Google Scholar 

  17. Raj KK, Taneja Y, Ramdev P, Dhaked SK, Singh CK, Shekar AP (2019) A prospective observational study to evaluate the role of restaging transurethral resection of bladder tumour in patients with non-muscle invasive bladder cancer. Int J Res Med Sci 7(11):4134

    Article  Google Scholar 

  18. Herr HW (1999) The value of a second transurethral resection in evaluating patients with bladder tumors. J Urol 162(1):74–76

    Article  CAS  Google Scholar 

  19. Calò B, Chirico M, Fortunato F, Sanguedolce F, Carvalho-Dias E, Autorino R et al (2019) Is Repeat Transurethral Resection Always Needed in High-Grade T1 Bladder Cancer? Front Oncol 4(9):465. https://doi.org/10.3389/fonc.2019.00465

    Article  Google Scholar 

  20. Soria F, D’Andrea D, Moschini M, Giordano A, Mazzoli S, Pizzuto G et al (2020) Predictive factors of the absence of residual disease at repeated transurethral resection of the bladder Is there a possibility to avoid it in well-selected patients? Urol Oncol Semin Orig Investig 38(3):77.e1-77.e7

    Google Scholar 

  21. Czech AK, Gronostaj K, Frydrych J, Fronczek J, Przydacz M, Wiatr T et al (2019) Identification of potential prognostic factors for absence of residual disease in the second resection of t1 bladder cancer. Cent Eur J Urol 72(3):252–257

    CAS  Google Scholar 

  22. Letašiová S, Medve'ová A, Šovčíková A, Dušinská M, Volkovová K, Mosoiu C, et al. Bladder cancer, a review of the environmental risk factors. Environ Health. 2012;11 Suppl 1(Suppl 1):S11. https://doi.org/10.1186/1476-069X-11-S1-S11

  23. Lunney A, Haynes A, Sharma P (2019) Moderate or severe LUTS is associated with increased recurrence of non - muscle - invasive urothelial carcinoma of the bladder. Int Braz J Urol 45(2):306–314

    Article  Google Scholar 

  24. Luo S, Lin Y, Zhang W (2011) Does simultaneous transurethral resection of bladder tumor and prostate affect the recurrence of bladder tumor? A meta-analysis J Endourol 25(2):291–296

    PubMed  Google Scholar 

  25. Ark JT, Keegan KA, Barocas DA, Morgan TM, Resnick MJ, You C et al (2014) Incidence and predictors of understaging in patients with clinical T1 urothelial carcinoma undergoing radical cystectomy. BJU Int 113(6):894–899

    Article  Google Scholar 

  26. van Dijk PR, Ploeg M, Aben KKH, Weijerman PC, Karthaus HFM, van Berkel JTH et al (2011) Downstaging of TURBT-based muscle-invasive bladder cancer by radical cystectomy predicts better survival. ISRN Urol 2011:1–6

    Article  Google Scholar 

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Acknowledgements

We acknowledge Dr Ajeet Singh Bhadoria, Department of Community and Family Medicine, for his valuable help in doing statistical analysis.

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Authors and Affiliations

  1. Department of Urology, AiimsRishikesh, Uttarakhand, India, 249203

    Deepak Prakash Bhirud, Ankur Mittal, Sunil Kumar, Tushar Aditya Narain, Shiv Charan Navriya, Satish Kumar Ranjan & Vikas Kumar Panwar

  2. Department of Pathology, AiimsRishikesh, Uttarakhand, India

    Sanjeev Kishore

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  1. Deepak Prakash Bhirud
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  2. Ankur Mittal
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Contributions

Conceptualization: Ankur Mittal, Sunil Kumar; methodology: Ankur Mittal, Sunil Kumar, Sanjeev Kishore; acquisition, analysis, or interpretation of data, drafted the work: Deepak Prakash Bhirud, Satish Ranjan; writing original draft: Deepak Prakash Bhirud; review and editing: Sunil Kumar, Tushar Aditya Narain, Vikas Kumar Panwar; all authors read and approved the final manuscript.

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Correspondence to Ankur Mittal.

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Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of AIIMS, Rishikesh, on 29.12.2018 with letter number AIIMS/IEC/18/573.

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Informed consent was obtained from all individual participants included in the study.

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Patients’ informed consent regarding publishing their data was obtained.

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The authors declare no competing interests.

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Bhirud, D.P., Mittal, A., Kumar, S. et al. When to Avoid a Restaging Procedure for Non-muscle Invasive Bladder Cancer? Inferences from a Tertiary Care Center. Indian J Surg Oncol 13, 604–611 (2022). https://doi.org/10.1007/s13193-022-01516-8

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  • DOI: https://doi.org/10.1007/s13193-022-01516-8

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