Oncological benefit of re-resection for T1 bladder cancer: a comparative effectiveness study.

Cystectomy / methods Humans Neoplasm Staging Prognosis Retrospective Studies Urinary Bladder Neoplasms / pathology Urologic Surgical Procedures
#BladderCancer #blcsm #uroonc bladder cancer cohort study comparative study effectiveness non-muscle-invasive bladder cancer observational study population-based study re-resection survival analysis transurethral resection

Journal

BJU international
ISSN: 1464-410X
Titre abrégé: BJU Int
Pays: England
ID NLM: 100886721

Informations de publication

Date de publication:
02 2022
Historique:
pubmed: 22 10 2021
medline: 15 4 2022
entrez: 21 10 2021
Statut: ppublish

Résumé

To quantify the real-world survival benefit of re-resection vs no re-resection in patients diagnosed with T1 bladder cancer (BC) at the population level. Retrospective population-wide observational cohort study based on pathology reports linked to health administrative data. We identified patients who were diagnosed with T1 BC in the province of Ontario (01/2001-12/2015) and used billing claims to ascertain whether they received re-resection within 2-10 weeks. The time-dependent effect of re-resection on survival outcomes was modelled by Cox proportional hazards regression (unadjusted and adjusted for numerous assumed patient- and surgeon-level confounding variables). Effect measures were presented as hazard ratios (HRs) and 95% confidence intervals (CIs). We identified 7666 patients of which 2162 (28.7%) underwent re-resection after a median (interquartile range) time of 45 (35-56) days. Patients who received re-resection were less likely to die from any causes (HR 0.68, 95% CI 0.63-0.74, P < 0.001) and from BC (HR 0.66, 95% CI 0.57-0.76, P < 0.001) during any time of follow-up. After adjusting for all assumed confounding variables, re-resection was still significantly associated with a lower overall mortality (HR 0.88, 95% CI 0.81-0.95, P < 0.001), while the association with cancer-specific survival marginally lost its statistical significance (HR 0.87, 95% CI 0.75-1.02, P = 0.08). A second transurethral resection within 2-6 weeks after the initial resection (i.e. re-resection) is recommended for patients diagnosed with primary T1 BC as prior studies suggest therapeutic, diagnostic, and prognostic benefits. However, results on survival endpoints are sparse, conflicting, and often affected by various biases. To the best of our knowledge, the present population-wide study represents the largest cohort of patients diagnosed with T1 BC and provides real-world evidence supporting the utilisation of re-resection in this group of patients.

Identifiants

DOI: 10.1111/bju.15622 PMID: 34674366
pubmed: 34674366
doi: 10.1111/bju.15622
doi:

Types de publication

Journal Article Observational Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

258-268

Commentaires et corrections

Type : CommentIn

Informations de copyright

© 2021 The Authors BJU International © 2021 BJU International.

Références

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Auteurs

Marian S Wettstein (MS)

Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
ICES, Toronto, ON, Canada.
Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
ORCID: 0000-0003-1378-3625

Nancy N Baxter (NN)

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
ICES, Toronto, ON, Canada.

Rinku Sutradhar (R)

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
ICES, Toronto, ON, Canada.

Muhammad Mamdani (M)

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
ICES, Toronto, ON, Canada.

Pham Song (P)

ICES, Toronto, ON, Canada.

Syed R Qadri (SR)

Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.

Kathy Li (K)

Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.

Ning Liu (N)

ICES, Toronto, ON, Canada.

Theodorus van der Kwast (T)

Department of Pathology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.

Thomas Hermanns (T)

Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.

Girish S Kulkarni (GS)

Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
ICES, Toronto, ON, Canada.

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Classifications MeSH

questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie urogénitale › Procédures de chirurgie urologique › Cystectomie › Oncological benefit of re-resection for T1...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Oncological benefit of re-resection for T1...
questionsmedicales.fr › Diagnostic › Pronostic › Stadification tumorale › Oncological benefit of re-resection for T1...
questionsmedicales.fr › Diagnostic › Pronostic › Oncological benefit of re-resection for T1...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Oncological benefit of re-resection for T1...
questionsmedicales.fr › Maladies urogénitales › Maladies urologiques › Tumeurs urologiques › Tumeurs de la vessie urinaire › Oncological benefit of re-resection for T1...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie urogénitale › Procédures de chirurgie urologique › Oncological benefit of re-resection for T1...