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Residual tumour in the marginal resection after a complete transurethral resection is associated with local recurrence in Ta/T1 urinary bladder cancer
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Health and Developmental Care, Regional Cancer Centre.
Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
2012 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 46, no 5, 343-347 p.Article in journal (Refereed) Published
Abstract [en]

Objective. This study investigated the presence of residual tumour in the marginal resection (MR) after a complete transurethral resection (TURB) of Ta/T1 transitional urinary bladder cancer. The association between positive MR and recurrence was analysed. Material and methods. After macroscopically complete TURB, a marginal resection of 7 mm (corresponding to the diameter of the resection loop) was removed around the entire resection area. Univariate and multivariate Cox regression analyses were performed to assess the influence of residual disease on recurrence. Results. In all, 94 patients with a median follow-up time of 36 months were included, and residual tumour in the MR was present in 24 (26%). The recurrence rates for all cases, for those with a tumour-positive and a tumour-free MR were 60 (64%), 20 (83%) and 40 (57%), respectively. Local recurrence was found in 14 (58%) of the patients with tumour presence in the MR compared to 13 (19%) of those with a tumour-free margin. A positive MR was significantly associated with overall recurrence (p andlt; 0.001) and local recurrence (p = 0.001). Conclusion. Incomplete transurethral resection of bladder cancer is common, as demonstrated in 26% patients with positive MR. The presence of tumour in the MR may be a risk factor for recurrence, and particularly local recurrence.

Place, publisher, year, edition, pages
Informa Healthcare , 2012. Vol. 46, no 5, 343-347 p.
Keyword [en]
edge of resection area, marginal resection, recurrence, residual tumour, Ta/T1 urinary bladder cancer, TURB
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-84884DOI: 10.3109/00365599.2012.684700ISI: 000308951000005OAI: oai:DiVA.org:liu-84884DiVA: diva2:564014
Available from: 2012-11-01 Created: 2012-10-26 Last updated: 2017-12-07
In thesis
1. Aspects of Recurrence and Progression in Ta/T1 Urinary Bladder Cancer
Open this publication in new window or tab >>Aspects of Recurrence and Progression in Ta/T1 Urinary Bladder Cancer
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims: To evaluate different aspects of recurrence and, when appropriate, progression in primary Ta/T1 urinary bladder cancer.

Patients and methods: All evaluable patients diagnosed with primary Ta/T1 urinary bladder cancer in Linköping and Norrköping between 1992 and 2007 were included prospectively in the study cohort. Histopathology results were classified according to the TNM system and were reviewed by a reference pathologist using the WHO 1999 criteria (except in the studies reported in Papers I and IV). Risk factors for local recurrence were evaluated using data from the period 1992–2001 (Paper I). Tumour size (Paper II) and bladder wash cytology (Paper III) at primary diagnosis were assessed regarding the impact on recurrence and progression, and tumour presence in the marginal resection in primary and recurrent Ta/T1 bladder cancer was investigated considering effects on recurrence in patients treated between 2001 and 2010 (Paper IV). Furthermore, surgical experience measured as training status (resident or specialist) and surgical volume (both during the study period and lifetime) were analysed regarding their influence on recurrence and progression (Paper V).

Results: Tumour size > 30 mm (p < 0.001) and multiplicity (p = 0.021) were significantly associated with local recurrence (Paper I). Tumour sizes 16–30 mm and > 30 mm were correlated with recurrence (p = 0.003 and p < 0.001, respectively) but not with progression (Paper II). High-grade malignant bladder wash cytology proved to be predictive of both recurrence (p < 0.001) and progression (p = 0.036) as was shown in Paper III. A tumour-positive marginal resection was related to overall (p < 0.001) and local (p < 0.001) recurrence (Paper IV). Transurethral resection of bladder tumours performed by residents was associated with recurrence (p = 0.004) but not with progression. No differences in relation to either recurrence or progression were found for the surgical volume approach at the chosen cut-offs (Paper V).

Conclusions: The present studies identified new risk factors for recurrence (tumours > 15 mm, high-grade bladder wash cytology at diagnosis, tumour-positive marginal resection, and surgery performed by residents) and progression (local recurrence and high-grade malignant bladder wash cytology at diagnosis), which in the future may be integrated into follow-up schedules or risk profiles for patients with Ta/T1 urinary bladder cancer.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 81 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1344
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89146 (URN)978-91-7519-738-8 (ISBN)
Public defence
2013-03-22, Eken salen, Hälsouniversitet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-02-22 Created: 2013-02-22 Last updated: 2015-06-05Bibliographically approved

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Jancke, GeorgRosell, JohanJahnson, Staffan

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