| Objective:Section one:To explore the efficacy and safety of repeat transurethral resection（Re-TURBT）in the treatment of non-muscle invasive bladder cancer（NMIBC）.Section two:To explore the prognosis of patients with different pathology reports,and to analyze the positive pathological reports and recurrence related risk factors.Section three:To report a clinical case of tumor implant recurrence found during Re-TURBT,and to analyze the reasons which is related to the recurrence of bladder tumor after transurethral resection of bladder tumor（TURBT）.Methods:Section one:The clinical data of patients with non-muscle invasive bladder cancer who underwent transurethral resection of bladder tumor in the Lanzhou University Second Hospital from January 2016 to December 2020 were retrospectively analyzed.A total of 749 patients were enrolled,all of whom met the indications for re-TURBT.They were divided into 669 cases in the TURBT group and80 cases in the Re-TURBT group.The patients in the two groups were matched by1:1 propensity score matching.After matching,we compared the baseline data and follow-up results of the two groups.We draw the survival curves by the Kaplan-Meier to analyze the recurrence free survival rate of the two group and use the log-rank method to analyze the differences between the two groups.The recurrence rate,the progression rate and complication rate between the two groups were compared,and the efficacy and safety of Re-TURBT in the treatment of patients with non-muscle invasive bladder cancer were analyzed.Section two:The clinical data of 80 NMIBC patients in the Re-TURBT group were retrospectively analyzed,and then the patients’baseline data,tumor characteristics and follow-up were further improved.When the pathological result of the Re-TURBT confirms the existence of urothelial carcinoma,the pathological result of the resection is positive.Patients were divided into a group with positive pathological reports and a negative group.The survival curve was plotted by using the Kaplan-Meier method.To obtain the RFS rates of the two groups and to use the log-rank test to compare the differences between the two groups.Cox regression analysis was used to analyze risk factors associated with bladder tumor recurrence.Section three:Based on the case report of the non-muscle invasive bladder cancer in 2018,we aim to compare the location of the primary injury site and recurrence site after re-TURBT and the pathological reports of the postoperative tumors,to analyze the reason behind the early recurrence of bladder tumors.Results:Section one:In the re-TURBT group,29 cases（36.3%）had positive pathological results,9 cases（11.25%）had pathological changes,7 cases were diagnosed from Ta to T1,and 2 case were increased from low pathological level to high level.Among the 51 negative reports,12 cases had epithelial atypical hyperplasia.150 patients in the two groups were successfully matched 1:1.The average follow-up time was 34.3 months（2.6～74.5 months）.46 patients（30.7%）had recurrence and 15patients（10%）had progression.One patient died of extensive metastasis in the Re-TURBT group and two patients died in the single resection group.The total recurrence rate of single resection group and re-TURBT group were 40%and 21.3%,and the difference was statistically significant（P=0.013）.The total progression rate of single resection group and re-TURBT group were 10.7%and 9.3%,and the difference was not statistically significant（P=0.79）.The RFS rates of the single resection group and the re-TURBT group in 1,2 and 3 years were 76.0%vs.89.3%、66.5%vs.81.1%、65.1%vs.79.6%,and the difference was statistically significant（P=0.029）.The total complication rate in the TURBT group was 6.67%（5/75）,and the complication rate in the Re-TURBT group was 17.3%（13/75）.There was a statistically significant difference between the two groups（P=0.044）.Section two:A total of 80 patients who underwent Re-TURBT were included,with 29 patients with positive pathological results and 51 patients with negative results.The mean follow-up time was 31.8 months（2.6～74.5 months）,and a total of18（22.5%）patients developed recurrence.Among them,12（41.4%）cases recurred in the positive group and 6 cases（11.8%）in the negative group recurred.A total of 8（10.0%）patients developed progression,5（17.2%）in the resection-positive group and3（5.9%）in the resection-negative group。There was a statistically significant difference in the total recurrence rate（P=0.004）;there was no significant difference in the total progression rate（P>0.05）.Kaplan-Meier survival analysis showed that the RFS rates of the positive pathological results group and the negative group in 1,2 and3 years were 86.2%%vs.94.0%、65.3%vs.90.0%、56.7%vs.90.0%,and the difference was statistically significant（Log-rank test x2=8.540,P=0.003）.Logistic regression analysis showed that tumors larger than 3 cm and satellite lesions were positive pathological reports independent risk factors for pathological results.In the analysis of recurrence-related factors,univariate COX analysis showed that:patient age,tumor size,tumor grade,and Re-TURBT results were all related to tumor recurrence after Re-TURBT in NMIBC patients;multivariate COX analysis indicated that the tumor size was greater than 3 cm high-grade tumor grade,positive pathological result of Re-TURBT was an independent risk factor for recurrence after resection of NMIBC patients.Section three:The tumor recurrence site seen in the patient’s re-TURBT was consistent with the injury site during the first TURBT,and the pathological results and immunohistochemistry of Re-TURBT were the same as the first time.It is reasonable to speculate that this patient was a recurrence of intraluminal implantation of bladder tumor.Conclusion:Section one:Re-TURBT for the treatment of non-muscle invasive bladder cancer patients can effectively reduce the postoperative recurrence rate and prolong the recurrence-free survival time.It is a safe and effective surgical method.Section two:The presence of satellite lesions and tumor diameter>3cm were independent risk factors for positive Re-TURBT,and patients with positive pathology reports had a worse prognosis than patients with negative pathology reports.The patients still had recurrence after the Re-TURBT,for whom the postoperative pathological results were positive,the tumor diameter was>3cm,and the risk of high-grade tumor recurrence was higher.Section Three:The seeding of tumor cells after TURBT may be one of the reasons for the short-term recurrence of bladder tumors.The Re-TURBT has significance for the early detection and treatment of recurrence in such patients. |
