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Does repeat transurethral resection of bladder tumor influence the diagnosis and prognosis of T1 bladder cancer? A systematic review and meta-analysis

  • Author Footnotes
    1 Lede Lin, Xiaotong Guo and Yucheng Ma have contributed equally to this work.
    Lede Lin
    Footnotes
    1 Lede Lin, Xiaotong Guo and Yucheng Ma have contributed equally to this work.
    Affiliations
    Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
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  • Author Footnotes
    1 Lede Lin, Xiaotong Guo and Yucheng Ma have contributed equally to this work.
    Xiaotong Guo
    Footnotes
    1 Lede Lin, Xiaotong Guo and Yucheng Ma have contributed equally to this work.
    Affiliations
    Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
    Search for articles by this author
  • Author Footnotes
    1 Lede Lin, Xiaotong Guo and Yucheng Ma have contributed equally to this work.
    Yucheng Ma
    Footnotes
    1 Lede Lin, Xiaotong Guo and Yucheng Ma have contributed equally to this work.
    Affiliations
    Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
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  • Jiang Zhu
    Correspondence
    Corresponding author.
    Affiliations
    Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
    Search for articles by this author
  • Xiang Li
    Correspondence
    Corresponding author.
    Affiliations
    Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
    Search for articles by this author
  • Author Footnotes
    1 Lede Lin, Xiaotong Guo and Yucheng Ma have contributed equally to this work.

      Abstract

      Background

      To reduce recurrence or progression of tumor, NCCN guidelines recommend repeat transurethral resection of bladder tumors (reTURB) for non-muscle-invasive bladder cancer (NMIBC). The study aims to compare the impact of initial TURB and reTURB on the rate of residual or upstaging tumors and short-term and long-term survival outcomes of T1 bladder cancer (BC).

      Materials and methods

      We searched through several public database, including PubMed, Embase, Ovid Medline and Ovid EBM Reviews - Cochrane Central Register of Controlled Trials. The latest search time was October 2021.

      Results

      In general, 68 articles were involved. Short-term RFS (1-year and 3-year) of reTURB group was better compared with TURB group in T1 patients. The pooled RR were 1.10 (95%CI: 1.01–1.19) and 1.15 (95%CI: 1.03–1.28), respectively. While reTURB did not improve long-term RFS (5-year, 10-year, 15-year) in T1 patients. The pooled RR were 1.12 (95%CI: 0.97–1.30), 1.11 (95%CI: 0.82–1.50) and 1.37 (95%CI: 0.50–3.74), respectively. Analysis of PFS, OS and CSS demonstrated similar outcomes with RFS. We found that about two-thirds of samples contained detrusor. The residual tumor rate in stage T1 was 0.48 (95%CI: 0.42–0.53). While the rate of upstaging in stage T1 was 0.10 (95%CI: 0.07–0.13).

      Conclusions

      In conclusion, reTURB might provide short-term survival benefits for T1 BC, but it was not the same for long-term outcomes. The residual and upstaging rates of T1 BC in reTURB were around 50% and 10%, respectively. Our study might be conducive to clinically informed consents when patients expressed their concerns about the necessity of reTURB and its impact on diagnosis, treatment and prognosis.

      Keywords

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