Clinical and pathological risk factors for tumour recurrence and upstaging in second TURBT for patients with NMIBC: a systematic review and meta-analysis

Zusammenfassung

Ziel Offenlegung signifikanter Risikofaktoren durch Identifizierung gepoolter Effektschätzungsstatistiken in einer systemischen Überprüfung und Metaanalyse klinischer und pathologischer Risikofaktoren, die ein Tumorrezidiv und ein Upstaging auf eine zweite TURBT bei Patienten mit hochgradigem NMIBC vorhersagen.

Material-Methode Alle Datenquellen wurden umfassend bis Oktober 2022 untersucht. Die Daten wurden aus den relevanten Studien extrahiert und mit der Software RevMan analysiert. In einem inversen Varianzmodell mit zufälligen und festen Effekten werden Odds Ratio (OR)-Werte mit 95%-Konfidenzintervallen [95%-KI] angegeben.

Ergebnisse Der Review umfasste insgesamt 18 Studien und 4548 Patienten. Gemäß den gepoolten Effektschätzern waren Carcinoma in situ (CIS), Tumorgrad, Multiplizität und Chirurgenfaktoren signifikante Risikofaktoren. Die gepoolten Effektschätzungen für das Tumorstadium und die Tumormorphologie waren sehr nahe an der Signifikanz. Für CIS, Grad, Multiplizität und Chirurgenfaktor, OR, IVR oder IVF [95%-KI] waren die p- und I2-Werte 1,8 [1,1, 3,0], 0,03, 75%; 2 [1,1, 3,4], 0,02, 53%; 1,3 [1,2, 1,6], <0,01, 40%; und 2 [1,4, 3], <0,01, 66%.

Schlussfolgerungen Als Ergebnis der ersten TURBT; Eine zweite TURBT sollte in den 2–6 Wochen der postoperativen Phase für Patienten mit hochgradigem, begleitendem CIS, multipler, solider Morphologie, DM(-) im pathologischen Präparat und NMIBC, das von Trainern/Juniorchirurgen operiert wird, geplant werden.

Abstract

Objective To reveal significant risk factors by identifying pooled effect estimates with a systematic review and meta-analysis of clinical and pathological risk factors predicting tumour recurrence and upstaging in a second transurethral resection of a bladder tumour (TURBT) in patients with high-grade non-muscle-invasive bladder cancer (NMIBC).

Material and Methods All data sources were broadly investigated up to October 2022. Data was extracted from the relevant studies and analysed with the RevMan software. In an inverse variance random and fixed effects model, Odds ratio (OR) values were given with 95% confidence intervals [95% CI].

Results The review included a total of 18 studies and 4548 patients. According to the pooled effect estimates, carcinoma in situ (CIS), tumour grade, multiplicity and surgeon factors were significant risk factors. Pooled effect estimates for tumour stage and tumour morphology were very close to significance. For CIS, grade, multiplicity and surgeon factor, OR, IVR or IVF [95% CI], p and I2 values were 1.8 [1.1, 3.0], 0.03, 75%; 2 [1.1, 3.4], 0.02, 53%, 1.3 [1.2, 1.6], <0.01, 40%, and 2 [1.4, 3], <0.01, 66%, respectively.

Conclusions NMIBC patients with a first TURBT performed by trainer or junior surgeons, with high grade among pathological risk factors and concomitant CIS and tumour multiplicity among clinical factors, have a high probability of tumour recurrence and upstaging in a second TURBT.

Keywords

second TURBT - risk factors - CIS - multiplicity - repeated TURBT

Schlüsselwörter

zweite TURBT - Re-TURBT - Risikofaktoren - CIS - Multiplizität

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