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1. COVID-19 pandemic impact on uro-oncological disease outcomes at an Italian tertiary referral center

Author

Gabriele Montefusco, Simone Mazzoli, Matteo De Bellis, Federica Peretti, Francesco Rosi, Giorgio Calleris, Andrea Giordano, Marco Oderda, Eugenia Vercelli, Alessandro Marquis, Federico Vitiello, Giuseppe Pizzuto, Francesco Soria, and Paolo Gontero

Subjects
Male, Nephrology, Urologic Neoplasms, medicine.medical_specialty, Urology, Cancer, Covid-19, Delay, Pathological outcomes, Upstaging, Uro-oncology, Aged, Aged, 80 and over, COVID-19, Communicable Disease Control, Cystectomy, Female, Humans, Italy, Middle Aged, Nephroureterectomy, Orchiectomy, Prostatectomy, Prostatic Neoplasms, Referral and Consultation, Retrospective Studies, Tertiary Care Centers, Testicular Neoplasms, Time-to-Treatment, Prostate cancer, Internal medicine, Biopsy, 80 and over, medicine, Stage (cooking), Lymph node, Testicular cancer, Bladder cancer, medicine.diagnostic_test, business.industry, medicine.disease, medicine.anatomical_structure, Original Article, business
Abstract

Purpose To assess differences in referral and pathologic outcomes for uro-oncology cases prior to and during the COVID pandemic, comparing clinical and pathological data of cancer surgeries performed at an academic referral center between 2019 and 2020. Methods We collected data of 880 prostate biopsies, 393 robot-assisted radical prostatectomies (RARP) for prostate cancer (PCa), 767 trans-urethral resections of bladder tumor (TURB) and 134 radical cystectomies (RC) for bladder cancer (BCa), 29 radical nephro-ureterectomies (RNU) for upper tract urothelial carcinoma, 130 partial nephrectomies (PN) and 12 radical nephrectomies (RN) for renal cancer, and 41 orchifunicolectomies for testicular cancer. Data of patients treated in 2019 (before COVID-19 pandemic) were compared to patients treated in 2020 (during pandemic). Results No significant decline in uro-oncological surgical activity was seen between 2019 and 2020. No significant increase in time between diagnosis and surgery was observed for all considered cancers. No differences in terms of main pathologic features were observed in patients undergoing RARP, TURB, RNU, RN/PN, or orchifunicolectomy. A higher proportion of ISUP grade 3 and 4 PCa were diagnosed in 2020 at biopsy (p = 0.001), but this did not translate into worse pathological grade/stage at RARP. In 2020, more advanced disease features were seen after RC, including lymph node involvement (p = 0.01) and non-organ confined disease (p = 0.02). Conclusion Neither decline in uro-oncologic activity nor delay between diagnosis and treatment was observed at our institution during the first year of COVID-19 pandemic. No significant worsening of cancer disease features was found in 2020 except for muscle-invasive BCa. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03842-y.

Published
2021
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2. Developing a Diagnostic Multivariable Prediction Model for Urinary Tract Cancer in Patients Referred with Haematuria: Results from the IDENTIFY Collaborative Study

Author

Sinan Khadhouri, Kevin M. Gallagher, Kenneth R. MacKenzie, Taimur T. Shah, Chuanyu Gao, Sacha Moore, Eleanor F. Zimmermann, Eric Edison, Matthew Jefferies, Arjun Nambiar, Thineskrishna Anbarasan, Miles P. Mannas, Taeweon Lee, Giancarlo Marra, Juan Gómez Rivas, Gautier Marcq, Mark A. Assmus, Taha Uçar, Francesco Claps, Matteo Boltri, Giuseppe La Montagna, Tara Burnhope, Nkwam Nkwam, Tomas Austin, Nicholas E. Boxall, Alison P. Downey, Troy A. Sukhu, Marta Antón-Juanilla, Sonpreet Rai, Yew-Fung Chin, Madeline Moore, Tamsin Drake, James S.A. Green, Beatriz Goulao, Graeme MacLennan, Matthew Nielsen, John S. McGrath, Veeru Kasivisvanathan, Aasem Chaudry, Abhishek Sharma, Adam Bennett, Adnan Ahmad, Ahmed Abroaf, Ahmed Musa Suliman, Aimee Lloyd, Alastair McKay, Albert Wong, Alberto Silva, Alexandre Schneider, Alison MacKay, Allen Knight, Alkiviadis Grigorakis, Amar Bdesha, Amy Nagle, Ana Cebola, Ananda Kumar Dhanasekaran, Andraž Kondža, André Barcelos, Andrea Benedetto Galosi, Andrea Ebur, Andrea Minervini, Andrew Russell, Andrew Webb, Ángel García de Jalón, Ankit Desai, Anna Katarzyna Czech, Anna Mainwaring, Anthony Adimonye, Arighno Das, Arnaldo Figueiredo, Arnauld Villers, Artur Leminski, Arvinda Chippagiri, Asim Ahmed Lal, Asıf Yıldırım, Athanasios Marios Voulgaris, Audrey Uzan, Aye Moh Moh Oo, Ayman Younis, Bachar Zelhof, Bashir Mukhtar, Ben Ayres, Ben Challacombe, Benedict Sherwood, Benjamin Ristau, Billy Lai, Brechtje Nellensteijn, Brielle Schreiter, Carlo Trombetta, Catherine Dowling, Catherine Hobbs, Cayo Augusto Estigarribia Benitez, Cédric Lebacle, Cherrie Wing Yin Ho, Chi-Fai Ng, Chloe Mount, Chon Meng Lam, Chris Blick, Christian Brown, Christopher Gallegos, Claire Higgs, Clíodhna Browne, Conor McCann, Cristina Plaza Alonso, Daniel Beder, Daniel Cohen, Daniel Gordon, Daniel Wilby, Danny Gordon, David Hrouda, David Hua Wu Lau, Dávid Karsza, David Mak, David Martin-Way, Denula Suthaharan, Dhruv Patel, Diego M Carrion, Donald Nyanhongo, Edward Bass, Edward Mains, Edwin Chau, Elba Canelon Castillo, Elizabeth Day, Elsayed Desouky, Emily Gaines, Emma Papworth, Emrah Yuruk, Enes Kilic, Eoin Dinneen, Erika Palagonia, Evanguelos Xylinas, Faizan Khawaja, Fernando Cimarra, Florian Bardet, Francesca Kum, Francesca Peters, Gábor Kovács, Geroge Tanasescu, Giles Hellawell, Giovanni Tasso, Gitte Lam, Giuseppe Pizzuto, Gordan Lenart, Günal Özgür, Hai Bi, Hannah Lyons, Hannah Warren, Hashim Ahmed, Helen Simpson, Helena Burden, Helena Gresty, Hernado Rios Pita, Holly Clarke, Hosam Serag, Howard Kynaston, Hugh Crawford-Smith, Hugh Mostafid, Hugo Otaola-Arca, Hui Fen Koo, Ibrahim Ibrahim, Idir Ouzaid, Ignacio Puche-Sanz, Igor Tomašković, Ilker Tinay, Iqbal Sahibzada, Isaac Thangasamy, Iván Revelo Cadena, Jacques Irani, Jakub Udzik, James Brittain, James Catto, James Green, James Tweedle, Jamie Borrego Hernando, Jamie Leask, Jas Kalsi, Jason Frankel, Jason Toniolo, Jay D. Raman, Jean Courcier, Jeevan Kumaradeevan, Jennifer Clark, Jennifer Jones, Jeremy Yuen-Chun Teoh, John Iacovou, John Kelly, John P. Selph, Jonathan Aning, Jon Deeks, Jonathan Cobley, Jonathan Olivier, Jonny Maw, José Antonio Herranz-Yagüe, Jose Ignacio Nolazco, Jose Manuel Cózar-Olmo, Joseph Bagley, Joseph Jelski, Joseph Norris, Joseph Testa, Joshua Meeks, Juan Hernandez, Juan Luis Vásquez, Karen Randhawa, Karishma Dhera, Katarzyna Gronostaj, Kathleen Houlton, Kathleen Lehman, Kathryn Gillams, Kelvin Adasonla, Kevin Brown, Kevin Murtagh, Kiki Mistry, Kim Davenport, Kosuke Kitamura, Laura Derbyshire, Laurence Clarke, Lawrie Morton, Levin Martinez, Louise Goldsmith, Louise Paramore, Luc Cormier, Lucio Dell'Atti, Lucy Simmons, Luis Martinez-Piñeiro, Luis Rico, Luke Chan, Luke Forster, Lulin Ma, Maria Camacho Gallego, Maria José Freire, Mark Emberton, Mark Feneley, Marta Viridiana Muñoz Rivero, Matea Pirša, Matteo Tallè, Matthew Crockett, Matthew Liew, Matthew Trail, Max Peters, Meghan Cooper, Meghana Kulkarni, Michael Ager, Ming He, Mo Li, Mohamed Omran Breish, Mohamed Tarin, Mohammed Aldiwani, Mudit Matanhelia, Muhammad Pasha, Mustafa Kaan Akalın, Nasreen Abdullah, Nathan Hale, Neha Gadiyar, Neil Kocher, Nicholas Bullock, Nicholas Campain, Nicola Pavan, Nihad Al-Ibraheem, Nikita Bhatt, Nishant Bedi, Nitin Shrotri, Niyati Lobo, Olga Balderas, Omar Kouli, Otakar Capoun, Pablo Oteo Manjavacas, Paolo Gontero, Paramananthan Mariappan, Patricio Garcia Marchiñena, Paul Erotocritou, Paul Sweeney, Paula Planelles, Peter Acher, Peter C. Black, Peter K Osei-Bonsu, Peter Østergren, Peter Smith, Peter-Paul Michiel Willemse, Piotr L. Chlosta, Qurrat Ul Ain, Rachel Barratt, Rachel Esler, Raihan Khalid, Ray Hsu, Remigiusz Stamirowski, Reshma Mangat, Ricardo Cruz, Ricky Ellis, Robert Adams, Robert Hessell, Robert J.A. Oomen, Robert McConkey, Robert Ritchie, Roberto Jarimba, Rohit Chahal, Rosado Mario Andres, Rosalyn Hawkins, Rotimi David, Rustom P. Manecksha, Sachin Agrawal, Syed Sami Hamid, Samuel Deem, Sanchia Goonewardene, Satchi Kuchibhotla Swami, Satoshi Hori, Shahid Khan, Shakeel Mohammud Inder, Shanthi Sangaralingam, Shekhar Marathe, Sheliyan Raveenthiran, Shigeo Horie, Shomik Sengupta, Sian Parson, Sidney Parker, Simon Hawlina, Simon Williams, Simone Mazzoli, Slawomir Grzegorz Kata, Sofia Pinheiro Lopes, Sónia Ramos, Sophie Rintoul-Hoad, Sorcha O'Meara, Steve Morris, Stacey Turner, Stefano Venturini, Stephanos Almpanis, Steven Joniau, Sunjay Jain, Susan Mallett, Sven Nikles, null Shahzad, Sylvia Yan, Tarq Toma, Teresa Cabañuz Plo, Thierry Bonnin, Tim Muilwijk, Tim Wollin, Timothy Shun Man Chu, Timson Appanna, Tom Brophy, Tom Ellul, Tomaž Smrkolj, Tracey Rowe, Troy Sukhu, Trushar Patel, Tullika Garg, Turhan Çaşkurlu, Uros Bele, Usman Haroon, Víctor Crespo-Atín, Victor Parejo Cortes, Victoria Capapé Poves, Vincent Gnanapragasam, Vineet Gauhar, Vinnie During, Vivek Kumar, Vojtech Fiala, Wasim Mahmalji, Wayne Lam, Yew Fung Chin, Yigit Filtekin, Yih Chyn Phan, Youssed Ibrahim, Zachary A Glaser, Zainal Adwin Abiddin, Zijian Qin, Zsuzsanna Zotter, Zulkifli Zainuddin, Khadhouri, Sinan, Gallagher, Kevin M., Mackenzie, Kenneth R., Shah, Taimur T., Gao, Chuanyu, Moore, Sacha, Zimmermann, Eleanor F., Edison, Eric, Jefferies, Matthew, Nambiar, Arjun, Anbarasan, Thineskrishna, Mannas, Miles P., Lee, Taeweon, Marra, Giancarlo, Gómez Rivas, Juan, Marcq, Gautier, Assmus, Mark A., Uçar, Taha, Claps, Francesco, Boltri, Matteo, La Montagna, Giuseppe, Burnhope, Tara, Nkwam, Nkwam, Austin, Toma, Boxall, Nicholas E., Downey, Alison P., Sukhu, Troy A., Antón-Juanilla, Marta, Rai, Sonpreet, Chin, Yew-Fung, Moore, Madeline, Drake, Tamsin, Green, James S. A., Goulao, Beatriz, Maclennan, Graeme, Nielsen, Matthew, Mcgrath, John S., Kasivisvanathan, Veeru, Chaudry, Aasem, Sharma, Abhishek, Bennett, Adam, Ahmad, Adnan, Abroaf, Ahmed, Suliman, Ahmed Musa, Lloyd, Aimee, Mckay, Alastair, Wong, Albert, Silva, Alberto, Schneider, Alexandre, Mackay, Alison, Knight, Allen, Grigorakis, Alkiviadi, Bdesha, Amar, Nagle, Amy, Cebola, Ana, Dhanasekaran, Ananda Kumar, Kondža, Andraž, Barcelos, André, Galosi, Andrea Benedetto, Ebur, Andrea, Minervini, Andrea, Russell, Andrew, Webb, Andrew, de Jalón, Ángel García, Desai, Ankit, Czech, Anna Katarzyna, Mainwaring, Anna, Adimonye, Anthony, Das, Arighno, Figueiredo, Arnaldo, Villers, Arnauld, Leminski, Artur, Chippagiri, Arvinda, Lal, Asim Ahmed, Yıldırım, Asıf, Voulgaris, Athanasios Mario, Uzan, Audrey, Oo, Aye Moh Moh, Younis, Ayman, Zelhof, Bachar, Mukhtar, Bashir, Ayres, Ben, Challacombe, Ben, Sherwood, Benedict, Ristau, Benjamin, Lai, Billy, Nellensteijn, Brechtje, Schreiter, Brielle, Trombetta, Carlo, Dowling, Catherine, Hobbs, Catherine, Benitez, Cayo Augusto Estigarribia, Lebacle, Cédric, Ho, Cherrie Wing Yin, Ng, Chi-Fai, Mount, Chloe, Lam, Chon Meng, Blick, Chri, Brown, Christian, Gallegos, Christopher, Higgs, Claire, Browne, Clíodhna, Mccann, Conor, Plaza Alonso, Cristina, Beder, Daniel, Cohen, Daniel, Gordon, Daniel, Wilby, Daniel, Gordon, Danny, Hrouda, David, Lau, David Hua Wu, Karsza, Dávid, Mak, David, Martin-Way, David, Suthaharan, Denula, Patel, Dhruv, Carrion, Diego M, Nyanhongo, Donald, Bass, Edward, Mains, Edward, Chau, Edwin, Canelon Castillo, Elba, Day, Elizabeth, Desouky, Elsayed, Gaines, Emily, Papworth, Emma, Yuruk, Emrah, Kilic, Ene, Dinneen, Eoin, Palagonia, Erika, Xylinas, Evanguelo, Khawaja, Faizan, Cimarra, Fernando, Bardet, Florian, Kum, Francesca, Peters, Francesca, Kovács, Gábor, Tanasescu, Geroge, Hellawell, Gile, Tasso, Giovanni, Lam, Gitte, Pizzuto, Giuseppe, Lenart, Gordan, Özgür, Günal, Bi, Hai, Lyons, Hannah, Warren, Hannah, Ahmed, Hashim, Simpson, Helen, Burden, Helena, Gresty, Helena, Rios Pita, Hernado, Clarke, Holly, Serag, Hosam, Kynaston, Howard, Crawford-Smith, Hugh, Mostafid, Hugh, Otaola-Arca, Hugo, Koo, Hui Fen, Ibrahim, Ibrahim, Ouzaid, Idir, Puche-Sanz, Ignacio, Tomašković, Igor, Tinay, Ilker, Sahibzada, Iqbal, Thangasamy, Isaac, Cadena, Iván Revelo, Irani, Jacque, Udzik, Jakub, Brittain, Jame, Catto, Jame, Green, Jame, Tweedle, Jame, Hernando, Jamie Borrego, Leask, Jamie, Kalsi, Ja, Frankel, Jason, Toniolo, Jason, Raman, Jay D., Courcier, Jean, Kumaradeevan, Jeevan, Clark, Jennifer, Jones, Jennifer, Teoh, Jeremy Yuen-Chun, Iacovou, John, Kelly, John, Selph, John P., Aning, Jonathan, Deeks, Jon, Cobley, Jonathan, Olivier, Jonathan, Maw, Jonny, Herranz-Yagüe, José Antonio, Nolazco, Jose Ignacio, Cózar-Olmo, Jose Manuel, Bagley, Joseph, Jelski, Joseph, Norris, Joseph, Testa, Joseph, Meeks, Joshua, Hernandez, Juan, Vásquez, Juan Lui, Randhawa, Karen, Dhera, Karishma, Gronostaj, Katarzyna, Houlton, Kathleen, Lehman, Kathleen, Gillams, Kathryn, Adasonla, Kelvin, Brown, Kevin, Murtagh, Kevin, Mistry, Kiki, Davenport, Kim, Kitamura, Kosuke, Derbyshire, Laura, Clarke, Laurence, Morton, Lawrie, Martinez, Levin, Goldsmith, Louise, Paramore, Louise, Cormier, Luc, Dell'Atti, Lucio, Simmons, Lucy, Martinez-Piñeiro, Lui, Rico, Lui, Chan, Luke, Forster, Luke, Ma, Lulin, Gallego, Maria Camacho, Freire, Maria José, Emberton, Mark, Feneley, Mark, Rivero, Marta Viridiana Muñoz, Pirša, Matea, Tallè, Matteo, Crockett, Matthew, Liew, Matthew, Trail, Matthew, Peters, Max, Cooper, Meghan, Kulkarni, Meghana, Ager, Michael, He, Ming, Li, Mo, Omran Breish, Mohamed, Tarin, Mohamed, Aldiwani, Mohammed, Matanhelia, Mudit, Pasha, Muhammad, Akalın, Mustafa Kaan, Abdullah, Nasreen, Hale, Nathan, Gadiyar, Neha, Kocher, Neil, Bullock, Nichola, Campain, Nichola, Pavan, Nicola, Al-Ibraheem, Nihad, Bhatt, Nikita, Bedi, Nishant, Shrotri, Nitin, Lobo, Niyati, Balderas, Olga, Kouli, Omar, Capoun, Otakar, Oteo Manjavacas, Pablo, Gontero, Paolo, Mariappan, Paramananthan, Marchiñena, Patricio Garcia, Erotocritou, Paul, Sweeney, Paul, Planelles, Paula, Acher, Peter, Black, Peter C., Osei-Bonsu, Peter K, Østergren, Peter, Smith, Peter, Willemse, Peter-Paul Michiel, Chlosta, Piotr L., Ul Ain, Qurrat, Barratt, Rachel, Esler, Rachel, Khalid, Raihan, Hsu, Ray, Stamirowski, Remigiusz, Mangat, Reshma, Cruz, Ricardo, Ellis, Ricky, Adams, Robert, Hessell, Robert, Oomen, Robert J. A., Mcconkey, Robert, Ritchie, Robert, Jarimba, Roberto, Chahal, Rohit, Andres, Rosado Mario, Hawkins, Rosalyn, David, Rotimi, Manecksha, Rustom P., Agrawal, Sachin, Hamid, Syed Sami, Deem, Samuel, Goonewardene, Sanchia, Swami, Satchi Kuchibhotla, Hori, Satoshi, Khan, Shahid, Mohammud Inder, Shakeel, Sangaralingam, Shanthi, Marathe, Shekhar, Raveenthiran, Sheliyan, Horie, Shigeo, Sengupta, Shomik, Parson, Sian, Parker, Sidney, Hawlina, Simon, Williams, Simon, Mazzoli, Simone, Grzegorz Kata, Slawomir, Pinheiro Lopes, Sofia, Ramos, Sónia, Rintoul-Hoad, Sophie, O'Meara, Sorcha, Morris, Steve, Turner, Stacey, Venturini, Stefano, Almpanis, Stephano, Joniau, Steven, Jain, Sunjay, Mallett, Susan, Nikles, Sven, Shahzad, Null, Yan, Sylvia, Toma, Tarq, Cabañuz Plo, Teresa, Bonnin, Thierry, Muilwijk, Tim, Wollin, Tim, Chu, Timothy Shun Man, Appanna, Timson, Brophy, Tom, Ellul, Tom, Smrkolj, Tomaž, Rowe, Tracey, Sukhu, Troy, Patel, Trushar, Garg, Tullika, Çaşkurlu, Turhan, Bele, Uro, Haroon, Usman, Crespo-Atín, Víctor, Parejo Cortes, Victor, Capapé Poves, Victoria, Gnanapragasam, Vincent, Gauhar, Vineet, During, Vinnie, Kumar, Vivek, Fiala, Vojtech, Mahmalji, Wasim, Lam, Wayne, Fung Chin, Yew, Filtekin, Yigit, Chyn Phan, Yih, Ibrahim, Youssed, Glaser, Zachary A, Abiddin, Zainal Adwin, Qin, Zijian, Zotter, Zsuzsanna, and Zainuddin, Zulkifli

Subjects
Renal cancer, Prostate cancer, Risk factors, Urology, Bladder cancer, Urothelial cancer, Risk factor, Urinary tract cancer, Haematuria, Risk Calculator
Abstract

Background: Patient factors associated with urinary tract cancer can be used to risk stratify patients referred with haematuria, prioritising those with a higher risk of cancer for prompt investigation. Objective: To develop a prediction model for urinary tract cancer in patients referred with haematuria. Design, setting, and participants: A prospective observational study was conducted in 10 282 patients from 110 hospitals across 26 countries, aged ≥16 yr and referred to secondary care with haematuria. Patients with a known or previous urological malignancy were excluded. Outcome measurements and statistical analysis: The primary outcomes were the presence or absence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC], and renal cancer). Mixed-effect multivariable logistic regression was performed with site and country as random effects and clinically important patient-level candidate predictors, chosen a priori, as fixed effects. Predictors were selected primarily using clinical reasoning, in addition to backward stepwise selection. Calibration and discrimination were calculated, and bootstrap validation was performed to calculate optimism. Results and limitations: The unadjusted prevalence was 17.2% (n = 1763) for bladder cancer, 1.20% (n = 123) for UTUC, and 1.00% (n = 103) for renal cancer. The final model included predictors of increased risk (visible haematuria, age, smoking history, male sex, and family history) and reduced risk (previous haematuria investigations, urinary tract infection, dysuria/suprapubic pain, anticoagulation, catheter use, and previous pelvic radiotherapy). The area under the receiver operating characteristic curve of the final model was 0.86 (95% confidence interval 0.85-0.87). The model is limited to patients without previous urological malignancy. Conclusions: This cancer prediction model is the first to consider established and novel urinary tract cancer diagnostic markers. It can be used in secondary care for risk stratifying patients and aid the clinician's decision-making process in prioritising patients for investigation. Patient summary: We have developed a tool that uses a person's characteristics to determine the risk of cancer if that person develops blood in the urine (haematuria). This can be used to help prioritise patients for further investigation.

Published
2022

3. Predictive factors of the absence of residual disease at repeated transurethral resection of the bladder. Is there a possibility to avoid it in well-selected patients?

Author

Paolo Gontero, Shahrokh F. Shariat, Alberto Briganti, Simone Mazzoli, Giuseppe Pizzuto, David D'Andrea, Vincenzo Altieri, Andrea Giordano, Marco Moschini, Renzo Colombo, Rodolfo Hurle, Francesco Soria, Soria, F., D'Andrea, D., Moschini, M., Giordano, A., Mazzoli, S., Pizzuto, G., Hurle, R., Colombo, R., Briganti, A., Altieri, V., Shariat, S. F., and Gontero, P.

Subjects
Detrusor muscle, Male, medicine.medical_specialty, Neoplasm, Residual, Urology, 030232 urology & nephrology, Cystectomy, Nomogram, Re-TURB, T1HG bladder cancer, 03 medical and health sciences, 0302 clinical medicine, Urethra, Predictive Value of Tests, Medicine, Humans, Prospective cohort study, Aged, Neoplasm Staging, Retrospective Studies, Bladder cancer, business.industry, Carcinoma in situ, Patient Selection, Retrospective cohort study, Predictive factors, Second look TURB, Middle Aged, medicine.disease, medicine.anatomical_structure, Oncology, Urinary Bladder Neoplasms, 030220 oncology & carcinogenesis, Concomitant, Cohort, Retreatment, Female, business
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.

Published
2020

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