Roman Tomaškin1, Boris Eliáš1, Pavol Slávik2, Karol Kajo2, Katarína Macháleková2, Ján Kliment1
Objective: To evaluate the quality of primary TURBT and establish the impact of clinical and histopathological tumor characteristics on incidence of residual tumor in primary intermediate and high risk non-muscle invasive bladder cancer (NMIBC). Materials and methods: All 260 consecutive patients with primary NMIBC treated at our department in 1991-2007 were included into this retrospective study. All of them fitted criteria assigned for repeat TURBT and in all cases intermediate or high risk tumor was diagnosed according to EAU Guidelines. We evaluated gender, age, pT stage, grade, number and diameter of tumors, presence of muscle in specimens, instillation of farmorubicin within 6 hours after TURBT. The quality of TURBT was determined upon absence of muscle in specimen, incidence of residual tumor and muscle invasive bladder cancer in reTURBT specimen. Univariate (Chi-square test, Mann-Whitney test) and multivariate (logistic regression) statistical methods were used for the analysis. Results: Mean age at the time of primary TURBT was 64 years (range 26-93 years, median 65 years). In most cases pT1 tumor was diagnosed (70 %), muscle was not present in 15.4 % of primary TURBT specimens. Repeat TURBT was performed in 124 cases, residual tumor was diagnosed in 50 (40 %) of them. Residual tumor was found in 44 % pT1, 26 % pTa and 35 % pTx tumors. Muscle invasion was confirmed in 3 (2.4 %) cases. Residual tumor was found in 27 % G1, 30 % G2 and 54 % G3 tumors or in 29 % low grade and 54 % high grade tumors. The highest risk of residual tumor (84 %) was found in case of more than 3 primary tumors in bladder cavity with diameter > 3 cm. Significant impacts of grade and cystoscopic finding on incidence of residual tumor were confirmed in univariate and multivariate analysis. Intravesical instillation of farmorubicin and pT stage did not influence the incidence of residual tumor. Conclusions: In our cohort of intermediate and high risk NMIBC the absence of muscle in primary specimens was found in 15 % of cases and residual tumor in 40 % of cases. Significant predictors of residual tumor were tumor grade and unfavorable cystoscopic finding. Incidence of disease under staging (2.4 %) was extremely low in our cohort of patients.