J Cancer 2018; 9(22):4250-4254. doi:10.7150/jca.26129

Research Paper

Predictors of Residual T1 High Grade on Re-Transurethral Resection in a Large Multi-Institutional Cohort of Patients with Primary T1 High-Grade/Grade 3 Bladder Cancer

Matteo Ferro1✉, Giuseppe Di Lorenzo2, Carlo Buonerba2,3, Giuseppe Lucarelli4, Giorgio Ivan Russo5, Francesco Cantiello6, Abdal Rahman Abu Farhan6, Savino Di Stasi7, Gennaro Musi1, Rodolfo Hurle8, Serretta Vincenzo9, Gian Maria Busetto10, Ettore De Berardinis10, Sisto Perdonà11, Marco Borghesi12, Riccardo Schiavina12, Gilberto L. Almeida13, Pierluigi Bove14, Estevao Lima15, Giovanni Grimaldi15, Deliu Victor Matei1, Francesco Alessandro Mistretta1, Nicolae Crisan16, Daniela Terracciano17, Verze Paolo18, Michele Battaglia2, Giorgio Guazzoni8, Riccardo Autorino19, Giuseppe Morgia3, Rocco Damiano4, Matteo Muto20, Roberto La Rocca18, Vincenzo Mirone18, Ottavio de Cobelli1,21, Mihai Dorin Vartolomei1,22

1. Division of Urology, European Institute of Oncology, Milan, Italy.
2. Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.
3. Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Italy.
4. Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy.
5. Department of Urology, University of Catania, Catania, Italy.
6. Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy.
7. Urology Unit, Policlinico Tor Vergata, University of Rome, Rome, Italy.
8. Department of Urology, Istituto Clinico Humanitas, Clinical and Research Hospital, Milan, Italy.
9. Division of Urology, University of Palermo, Palermo, Italy.
10. Department of Urology, La Sapienza University of Rome, Rome, Italy.
11. Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Naples, Italy.
12. Department of Urology, University of Bologna, Bologna, Italy.
13. Department of Urology, University of Vale do Itajaí, Itajaí, Brazil.
14. Department of Experimental Medicine and Surgery, Urology Unit, Azienda Policlinico Tor Vergata, Rome, Italy.
15. Department of CUF Urology and Life and Health Sciences Research Institute, School of Medicine, University of Minho, Portugal.
16. Department of Urology, University of Medicine and Pharmacy “Iuliu Hațieganu”, Cluj-Napoca, Romania.
17. Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.
18. Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy.
19. Division of Urology, Virginia Commonwealth University, Richmond, VA, USA.
20. Department of Clinical Medicine and Surgery, Federico II University Medical School of Naples, Italy.
21. University of Milan, Milan, Italy.
22. Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania.

Abstract

The aim of this multi-institutional study was to identify predictors of residual high-grade (HG) disease at re-transurethral resection (reTUR) in a large cohort of primary T1 HG/Grade 3 (G3) bladder cancer patients.

A total of 1155 patients with primary T1 HG/G3 bladder cancer from 13 academic institutions that underwent a reTUR within 6 weeks after first TUR were evaluated. Logistic regression analysis was performed to assess the association of predictive factors with residual HG at reTUR.

Residual HG cancer was found in 288 (24.9%) of patients at reTUR. Patients presenting residual HG cancer were more likely to have carcinoma in situ (CIS) at first resection (p<0.001), multiple tumors (p=0.02), and tumor size larger than 3 cm (p=0.02). Residual HG disease at reTUR was associated with increased preoperative neutrophil-to-lymphocytes ratio (NLR) (p=0.006) and body mass index (BMI)>=25 kg/m2. On multivariable analysis, independent predictors for HG residual disease at reTUR were tumor size >3cm (OR = 1.37; 95% CI: 1.02-1.84, p=0.03), concomitant CIS (OR 1.92; 95% CI: 1.32-2.78, p=0.001), being overweight (OR= 2.08; 95% CI: 1.44-3.01, p<0.001) and obesity (OR 2.48; 95% CI: 1.64-3.77, p<0.001).

A reTUR in high grade T1 bladder cancer is mandatory as about 25% of patients, presents residual high grade disease. Independent predictors to identify patients at risk of residual high grade disease after a complete TUR include tumor size, presence of carcinoma in situ, and BMI >=25 kg/m2.

Keywords: bladder cancer, neutrophil-to-lymphocytes ratio, re-transurethral resection, high-grade

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How to cite this article:
Ferro M, Di Lorenzo G, Buonerba C, Lucarelli G, Russo GI, Cantiello F, Farhan ARA, Di Stasi S, Musi G, Hurle R, Vincenzo S, Busetto GM, De Berardinis E, Perdonà S, Borghesi M, Schiavina R, Almeida GL, Bove P, Lima E, Grimaldi G, Matei DV, Mistretta FA, Crisan N, Terracciano D, Paolo V, Battaglia M, Guazzoni G, Autorino R, Morgia G, Damiano R, Muto M, Rocca RL, Mirone V, de Cobelli O, Vartolomei MD. Predictors of Residual T1 High Grade on Re-Transurethral Resection in a Large Multi-Institutional Cohort of Patients with Primary T1 High-Grade/Grade 3 Bladder Cancer. J Cancer 2018; 9(22):4250-4254. doi:10.7150/jca.26129. Available from http://www.jcancer.org/v09p4250.htm