Detrusor Muscle in the First, Apparently Complete Transurethral Resection of Bladder Tumour Specimen Is a Surrogate Marker of Resection Quality, Predicts Risk of Early Recurrence, and Is Dependent on Operator Experience
Detrusor Muscle in the First, Apparently Complete Transurethral Resection of Bladder Tumour Specimen Is a Surrogate Marker of Resection Quality, Predicts Risk of Early Recurrence, and Is Dependent on Operator Experience
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DOI：
10.1016/j.eururo.2009.05.047
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发表时间：
2010-05-01
期刊：
影响因子：
23.4
通讯作者：
Grigor, Kenneth M.
中科院分区：
文献类型：
--
作者：
Mariappan, Paramananthan;Zachou, Alexandra;Grigor, Kenneth M.
背景资料：欧洲癌症研究和治疗组织对多中心试验的分析发现，首次随访膀胱镜检查（RR-FFC）的复发率存在显著的机构间差异，并将其归因于可变的经尿道膀胱肿瘤切除术（TURBT）质量。目的：为了确定是否切除逼尿肌（DM）的第一，明显完整的TURBT是质量的替代标记，是否存在DM取决于外科医生的经验。设计、设置和参与者：在2年的时间里，从我们前瞻性维护的膀胱肿瘤数据库中招募被判断为已完全切除的新发膀胱肿瘤患者。严格的排除criterions.Measurements：PROCESSING记录肿瘤大小，肿瘤多样性，外科医生的类别，DM状态，肿瘤的等级和阶段，并在第一次随访膀胱镜检查（在3个月）和早期再TURBT的结果进行了评价。外科医生分为老年人（顾问和5年或6年的学员）和初级（低于5年的学员）。早期复发（用于计算RR-FFC）定义为早期再次TURBT时病理证实的肿瘤或首次随访膀胱镜检查时复发。Logistic回归多变量分析进行了确定变量之间的关联。结果和限制：在356例患者中，DM是目前在241例（67.7%）。多变量分析显示，大肿瘤，高级别肿瘤，并由资深外科医生手术是独立相关的存在DM切除标本。当DM不存在和存在时，RR-FFC分别为44.4%和21.7%（比值比：2.9; 95%置信区间：1.6-5.4; p = 0.0002）。无糖尿病和由经验不足的外科医生切除独立预测较高的RR-FFC。这种关联也见于小的和低级别的肿瘤。在这项研究中的患者数量似乎不大，并进一步验证可能是requires.Conclusions：DM的存在或缺失，显然是完整的TURBT标本的切除质量的替代标记，独立预测的RR-FFC，这也是依赖于外科医生的经验。(C)2009年欧洲泌尿外科协会。由Elsevier B出版。版权所有© 2016
Background: An European Organisation for Research and Treatment of Cancer analysis of multicentre trials found significant interinstitutional variability in recurrence rates at first follow-up cystoscopy (RR-FFC) and attributed this to variable transurethral resection of bladder tumour (TURBT) quality.Objective: To determine whether resection of detrusor muscle (DM) in the first, apparently complete TURBT is a surrogate marker of quality and whether the presence of DM is dependent on a surgeon's experience.Design, setting, and participants: Over a 2-yr period, patients with new bladder tumours that were judged to have been completely resected were recruited from our prospectively maintained bladder tumour database. Strict exclusion criteria were applied.Measurements: Prospectively recorded tumour size, tumour multiplicity, surgeon category, DM status, grade and stage of tumour, and findings at first follow-up cystoscopy (at 3 mo) and at early re-TURBT were evaluated. Surgeons were stratified into seniors (consultants and year 5 or year 6 trainees) and juniors (trainees lower than year 5). Early recurrence (for calculating RR-FFC) was defined as pathologically confirmed tumour on early re-TURBT or recurrence at the first follow-up cystoscopy. Logistic regression multivariate analyses were carried out to determine associations between variables.Results and limitations: In a total of 356 patients, DM was present in 241 patients (67.7%). Multivariate analyses revealed that large tumours, high-grade tumours, and surgery by senior surgeons was independently associated with the presence of DM in the resected specimens. The RR-FFCs when DM was absent and present were 44.4% and 21.7%, respectively (odds ratio: 2.9; 95% conlfidence interval: 1.6-5.4; p = 0.0002). The absence of DM and resection by less experienced surgeons independently predicted a higher RR-FFC. This association was also seen in small and low-grade tumours. The number of patients in this study appears modest, and further validation may be required.Conclusions: DM absence or presence in the first, apparently complete TURBT specimen appears to be a surrogate marker of resection quality by independently predicting the RR-FFC, which is also dependent on surgeon experience. (C) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved.