title: Oncological outcomes of a single but extensive transurethral resection followed by appropriate intra-vesical instillation therapy for newly diagnosed non-muscle-invasive bladder cancer.
abstract: OBJECTIVE
  A second transurethral resection (TUR) has been recommended by guidelines for high-grade non-muscle-invasive bladder cancer (NMIBC). However, the impact of surgical quality and post-TUR intra-vesical instillation therapy on oncologic outcome still remains unclear for newly diagnosed NMIBC. We conducted a retrospective cohort study for the patients who underwent extensive TUR followed by appropriate intra-vesical therapy for newly diagnosed NMIBC to assess their oncological outcomes.
  
  
  METHODS
  We treated a cohort of 150 patients with NMIBC by our single but extensive TUR protocol at Hirosaki University Hospital between January 2005 and May 2012. The extensive TUR procedure comprised complete resection of all visible tumors including the muscle layer with a separate cold cup-biopsy of the marginal bottom. After visible tumors resection, additional resection for 5 mm wider area around the first surgical margin was performed. TUR was conducted by three expert urologists who had common agreement with the extensive TUR. All patients received 50 mg of epirubicin instillation immediately after TUR. Out of 150 patients, 74 patients who had multiple tumors or high-grade T1 disease received 40 mg of bacillus Calmette-Guérin Tokyo 172 strain once a week for six consecutive weeks. Patients who received second TUR were not included. The endpoints in this study were the recurrence-, progression-free, cancer-specific, and overall survivals.
  
  
  RESULTS
  The 5-year recurrence- and progression-free survival rates were 77.2 and 98.0 %, respectively. The 5-year cancer-specific and overall survival rates were 98.0 and 92.6 %, respectively. The 5-year recurrence- and progression-free survival rates in high-grade T1 disease were 77.1 and 97.6 %, respectively, which were not significantly different from those in the cohort with Ta or low-grade BC. Cystoscopy revealed that 93 % of the patients were tumor-free, at the first cystoscopy, and four patients (3 %) showed progression to stage T2 or higher disease during the first year.
  
  
  CONCLUSIONS
  While the present study has several limitations, including single-arm and retrospective nature, a single but extensive TUR combined with adjuvant intravesical treatment may have acceptable oncological outcomes in NMIBC patients.
authors.affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan, goodwin@hirosaki-u.ac.jp.
authors.forename: Takuya
authors.initials: T
authors.lastname: Koie
authors.forename: Chikara
authors.initials: C
authors.lastname: Ohyama
authors.forename: Shogo
authors.initials: S
authors.lastname: Hosogoe
authors.forename: Hayato
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Imai
authors.forename: Shingo
authors.initials: S
authors.lastname: Hatakeyama
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yoneyama
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Tohru
authors.initials: T
authors.lastname: Yoneyama
authors.forename: Yuki
authors.initials: Y
authors.lastname: Tobisawa
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Mori
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000283:Administration, Intravesical; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D001500:BCG Vaccine / Q000008:administration & dosage*; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods*; D003558:Cystoscopy / Q000379:methods*; D018450:Disease Progression; D018572:Disease-Free Survival; D015251:Epirubicin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D000276:Adjuvants, Immunologic; D000903:Antibiotics, Antineoplastic; D001500:BCG Vaccine; D015251:Epirubicin