Context

Initial treatment for most bladder cancers (BCs) involves transurethral resection (TUR) or tumours. Often more cancer is found after the initial treatment in around half of patients, requiring a second resection. Repeat transurethral resection (reTUR) is recommended for high-risk, non–muscle-invasive bladder cancer (NMIBC) to remove any residual disease and improve cancer outcomes.

Objective

To systematically review the practice and therapeutic benefit of an early reTUR for high-risk NMIBC.

Evidence acquisition

A systematic review of original articles was performed using PubMed/Medline and Web of Science databases in December 2016 (initial) and October 2017 (final). We searched the references of included papers.

Evidence synthesis

We screened 15 209 manuscripts and selected 31 detailing 8409 persons with high-grade Ta and T1BC for inclusion. Detrusor muscle was found at initial TUR histology in 30–100% of cases. Residual tumour at reTUR was found in 17–67% of patients following Ta and in 20–71% following T1 cancer. Most residual tumours (36–86%) were found at the original resection site. Upstaging occurred in 0–8% (Ta to ≥T1) and 0–32% (T1 to ≥T2) of cases. Conflicting data report the impact of reTUR on subsequent recurrence and cancer-specific mortality. Recurrence for Ta was 16% in the reTUR group versus 58% in the non-reTUR group. For T1, recurrence ranged from 18% to 56%, but no clear trend was identified between reTUR and control. No clear relationship between reTUR and progression was found for Ta, although for T1 rates were higher in the non-reTUR group in series with control populations (5/6 studies). Overall mortality was slightly reduced in the reTUR group in two studies with controls (22–30% vs 26–36% [no reTUR]).

Conclusions

Residual tumour is common after TUR for high-risk NMIBC. The reTUR helps in the diagnosis of this residual cancer and may improve outcomes for cancers initially staged as T1.

Patient summary

Some bladder cancers (BCs) are aggressive but confined to the bladder surface. Initial treatment includes endoscopic resection. More cancer is found after the initial treatment in approximately half of patients. In the aggressive but confined group of BC, a second resection, a few weeks after the first, may help find this residual cancer and improve outcomes, although the evidence quality for this is weak.

中文翻译：

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非肌肉浸润性膀胱癌重复经尿道切除术：系统评价

语境

大多数膀胱癌（BCs）的初始治疗包括经尿道切除术（TUR）或肿瘤。在大约一半的患者中，初次治疗后通常会发现更多的癌症，需要再次切除。对于高危，非肌肉浸润性膀胱癌（NMIBC），建议重复经尿道切除术（reTUR），以清除残留的疾病并改善癌症结局。

客观的

为了系统地审查早期reTUR对高风险NMIBC的实践和治疗益处。

取证

在2016年12月（初始）和2017年10月（最终）使用PubMed / Medline和Web of Science数据库对原始文章进行了系统评价。我们搜索了包含论文的参考文献。

证据综合

我们筛选了15209篇手稿，并选择了31篇详细列出了8409名具有高品位Ta和T1BC的人。在最初的TUR组织学检查中发现逼尿肌30–100％。reTUR残留的肿瘤在Ta术后17–67％的患者和T1癌症后20–71％的患者中发现。大多数残留肿瘤（36–86％）是在原始切除部位发现的。升级发生在0–8％（Ta至≥T1）和0–32％（T1至≥T2）的情况下。有矛盾的数据报道了reTUR对随后复发和癌症特异性死亡率的影响。在reTUR组中Ta的复发率为16％，而在非reTUR组中为58％。对于T1，复发率在18％至56％之间，但在reTUR和对照之间未发现明显趋势。对于Ta，reTUR与进展之间没有明确的关系，尽管在非reTUR组中，与对照组相比，T1的发生率较高（5/6研究）。在两项有对照组的研究中，reTUR组的总死亡率略有降低（22–30％比26–36％[无reTUR]）。

结论

高危NMIBC在TUR后残留肿瘤很常见。reTUR有助于诊断这种残留的癌症，并可能改善最初以T1分期的癌症的预后。

病人总结

一些膀胱癌（BCs）具有侵略性，但仅限于膀胱表面。初始治疗包括内窥镜切除术。大约一半的患者在初始治疗后发现更多的癌症。在积极进取但局限的BC组中，第一次切除后数周进行第二次切除可能有助于发现这种残留癌并改善预后，尽管证据质量较弱。