Francesco Soria1, David D'Andrea2, Marco Moschini3, Andrea Giordano4, Simone Mazzoli4, Giuseppe Pizzuto4, Rodolfo Hurle5, Renzo Colombo6, Alberto Briganti6, Vincenzo Altieri7, Shahrokh F Shariat8, Paolo Gontero4. 1. Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy. Electronic address: francesco.soria@unito.it. 2. Department of Urology, Medical University of Vienna, Vienna, Austria. 3. Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy. 4. Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy. 5. Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Milan, Italy. 6. Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy. 7. Department of Urology, University of Salerno, Salerno, Italy. 8. Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Weill Cornell Medical College, New York, NY.
Abstract
PURPOSE: To evaluate the predictive factors of pT0 at repeated transurethral resection of the bladder (re-TURB) in pT1 high-grade (HG) nonmuscle invasive bladder cancer in order to explore the possibility to avoid it in well-selected patients. METHODS: This multicenter retrospective study included patients with pT1HG nonmuscle invasive bladder cancer from 4 different centers who underwent a complete TURB. Re-TURB was defined as a second resection which involved the site of the first TURB performed within 2-6 weeks from the previous resection. A multivariable logistic-regression model was performed to evaluate the predictors of pT0 at re-TURB. A nomogram was built to calculate the probability of obtaining a negative histology at re-TURB. The performance of the nomogram and its net benefit were tested with the decision curve analysis. RESULTS: Overall, 321 patients were included in the study. On multivariable logistic regression, detrusor muscle in the specimen (HR 1.99, P = 0.02), concomitant carcinoma in situ (HR 0.29, P = 0.005) and resection performed with en-bloc technique (HR 7.71, P = 0.01) were independent predictors of pT0 at re-TURB. Decision curve analysis showed a net benefit for the nomogram for each probability over 0.35 compared to the strategy to perform a re-TURB in all pT1HG tumors. CONCLUSIONS: The presence of detrusor muscle in TURB specimen, the absence of concomitant carcinoma in situ and the en-bloc resection were able to predict a negative histology at re-TURB, opening the door to the possibility to avoid it in an extremely well-selected cohort of patients. External validations and prospective studies are urgently needed.
PURPOSE: To evaluate the predictive factors of pT0 at repeated transurethral resection of the bladder (re-TURB) in pT1 high-grade (HG) nonmuscle invasive bladder cancer in order to explore the possibility to avoid it in well-selected patients. METHODS: This multicenter retrospective study included patients with pT1HG nonmuscle invasive bladder cancer from 4 different centers who underwent a complete TURB. Re-TURB was defined as a second resection which involved the site of the first TURB performed within 2-6 weeks from the previous resection. A multivariable logistic-regression model was performed to evaluate the predictors of pT0 at re-TURB. A nomogram was built to calculate the probability of obtaining a negative histology at re-TURB. The performance of the nomogram and its net benefit were tested with the decision curve analysis. RESULTS: Overall, 321 patients were included in the study. On multivariable logistic regression, detrusor muscle in the specimen (HR 1.99, P = 0.02), concomitant carcinoma in situ (HR 0.29, P = 0.005) and resection performed with en-bloc technique (HR 7.71, P = 0.01) were independent predictors of pT0 at re-TURB. Decision curve analysis showed a net benefit for the nomogram for each probability over 0.35 compared to the strategy to perform a re-TURB in all pT1HG tumors. CONCLUSIONS: The presence of detrusor muscle in TURB specimen, the absence of concomitant carcinoma in situ and the en-bloc resection were able to predict a negative histology at re-TURB, opening the door to the possibility to avoid it in an extremely well-selected cohort of patients. External validations and prospective studies are urgently needed.
Authors: Mihaela Georgiana Musat; Christina Soeun Kwon; Elizabeth Masters; Slaven Sikirica; Debduth B Pijush; Anna Forsythe Journal: Clinicoecon Outcomes Res Date: 2022-01-10
Authors: David D'Andrea; Francesco Soria; Anne J Grotenhuis; Eugene K Cha; Nuria Malats; Savino Di Stasi; Steven Joniau; Tommaso Cai; Bas W G van Rhijn; Jaques Irani; Jeffrey Karnes; John Varkarakis; Jack Baniel; Joan Palou; Marek Babjuk; Martin Spahn; Peter Ardelt; Renzo Colombo; Vincenzo Serretta; Guido Dalbagni; Paolo Gontero; Riccardo Bartoletti; Stephane Larré; Per-Uno Malmstrom; Richard Sylvester; Shahrokh F Shariat Journal: World J Urol Date: 2021-03-13 Impact factor: 4.226
Authors: David D'Andrea; Surena Matin; Peter C Black; Firas G Petros; Homayoun Zargar; Colin P Dinney; Michael S Cookson; Wassim Kassouf; Marc A Dall'Era; John S McGrath; Jonathan L Wright; Andrew C Thorpe; Todd M Morgan; Jeffrey M Holzbeierlein; Trinity J Bivalacqua; Srikala S Sridhar; Scott North; Daniel A Barocas; Yair Lotan; Andrew J Stephenson; Bas W van Rhijn; Philippe E Spiess; Siamak Daneshmand; Shahrokh F Shariat Journal: BJU Int Date: 2020-10-14 Impact factor: 5.588
Authors: Marco Paciotti; Paolo Casale; Piergiuseppe Colombo; Vittorio Fasulo; Alberto Saita; Giovanni Lughezzani; Roberto Contieri; Nicolò Maria Buffi; Massimo Lazzeri; Giorgio Guazzoni; Rodolfo Hurle Journal: Eur Urol Open Sci Date: 2021-02-24