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Restaging TURB : 언제 어떻게 하는 것이 좋은가?
한경식(Kyung-sik Han),홍범식(Bumsik Hong) 대한비뇨기종양학회 2014 대한비뇨기종양학회지 Vol.12 No.2
Approximately 70% to 75% of patients with bladder cancer initially present at a low stage (stage 1), a category that includes carcinoma in situ (CIS, 1-10% alone as primary), tumors confined to the urothelial mucosa (Ta, 70%-80%), and those that invade only the underlying lamina propria (T1, 20%). The prognosis for patients with non-muscle invasive bladder cancer (NMIBC) is generally good, with approximately 80% to 90% of patients alive at 5 years. In contrast, muscle-invasive bladder cancer, which represents about 25% of cases, has a significantly lower relative 5-year survival rate of 17% to 66% depending on tumor stage. Thus, adequate TUR is critical not only to ensure accurate staging and guide future management options, but also to remove all tumors from the bladder. However, understaging rates of up to 40% for NMIBC have been reported based on radical cystectomy data. Moreover, absence of muscularis propria in the specimen leads to a significantly higher rate of understaging (50-78%). In these cases, restaging transurethral resection (TUR) should be performed. In addition, patients with high-grade (HG) Ta and HG T1 tumors, regardless of presence of muscle, are also strongly encouraged to undergo a restaging TUR. Restaging resection should be performed 2 to 6 weeks following initial TUR. Deep biopsies in the base and periphery of the old resection site should be performed. The goal of restaging TUR is threefold: to improve staging accuracy, resect any residual tumor, and potentially to improve the response to intravesical treatment.
Effect of decreased renal function on poor oncological outcome after radical cystectomy
김동수,남욱,경윤수,유달산,정인갑,홍범식(Bumsik Hong),홍준혁,안한종,임범진 대한비뇨의학회 2023 Investigative and Clinical Urology Vol.64 No.4
Purpose: To evaluate the impact of preoperative renal impairment on the oncological outcomes of patients with urothelial carcinoma who underwent radical cystectomy. Materials and Methods: We retrospectively reviewed the medical records of patients with urothelial carcinoma who underwent radical cystectomy from 2004 to 2017. All patients who underwent preoperative 99mTc-diethylenetriaminepentaacetic acid renal scintigraphy (DTPA) were identified. We divided the patients into two groups according to their glomerular filtration rates (GFRs): GFR group 1, GFR≥90 mL/min/1.73 m2; GFR group 2, 60≤GFR<90 mL/min/1.73 m2. We included 89 patients in GFR group 1 and 246 patients in GFR group 2 and compared the clinicopathological characteristics and oncological outcomes between the two groups. Results: The mean time required for recurrence was 125.5±8.0 months in GFR group 1 and 85.7±7.4 months in GFR group 2 (p=0.030). The mean cancer-specific survival was 131.7±7.8 months in GFR group 1 and 95.5±6.9 months in GFR group 2 (p=0.051). The mean overall survival was 123.3±8.1 months in GFR group 1 and 79.5±6.6 months in GFR group 2 (p=0.004). Conclusions: Preoperative GFR values in the range of 60≤GFR<90 mL/min/1.73 m2 are independent prognostic factors for poor recurrence-free survival, cancer-specific survival, and overall survival in patients after radical cystectomy compared with GFR values of ≥90 mL/min/1.73 m2.
Risk Factors Leading to Radical Cystectomy in Patients Who Had Undergone Nephroureterectomy
Janghui Lee(이장희),Bumjin Lim(임범진),Dalsan You(유달산),In Gab Jeong(정인갑),Cheryn Song(송채린),Jun Hyuk Hong(홍준혁),Choung-Soo Kim(김청수),Hanjong Ahn(안한종),Bumsik Hong(홍범식) 대한비뇨기종양학회 2021 대한비뇨기종양학회지 Vol.19 No.4
Purpose: To identify the risk factors leading to radical cystectomy in patients who had undergone nephroureterectomy (NUx). Materials and Methods: We retrospectively reviewed the medical records of patients with upper tract urothelial carcinoma who underwent NUx during 2011–2019 and excluded patients with metastatic cancer. In total 646 patients were included in this study; of these, 532 had no previous bladder cancer history. Follow-up was performed every 3 months for 2 years after NUx was administered, and recurrence was confirmed using cystoscopy, urine cytology, computed tomography, and chest radiography. Bladder recurrence was confirmed through biopsy, urine cytology, or radiologic examination. Univariate and multivariate Cox regression analyzes were performed for statistical analysis of risk factors leading to radical cystectomy in patients undergoing NUx. Results: Lymphovascular invasion (LVI) (hazard ratio [HR], 4.728; 95% confidence interval [CI], 1.463–15.570; p=0.011), previous transurethral resection of bladder tumor history (HR, 3.825; 95% CI, 1.164–12.571; p=0.027), and intravesical recurrence (IVR) within 6 months (HR, 3.733; 95% CI, 1.091–12.778; p=0.036) in patients undergoing NUx are predictors of radical cystectomy implementation. In a multivariate analysis of patients without bladder cancer history, bladder recurrence was identified as a predictor of radical cystectomy implementation, if it occurred within 6 months of NUx (HR, 8.608; 95% CI, 1.545–47.976; p=0.014). Conclusions: LVI and IVR within 6 months and previous bladder cancer history are factors that can predict the need for radical cystectomy after NUx. Even in patients without bladder cancer history, early bladder recurrence within 6 months is a major predictor of radical cystectomy.
Utility of Urinalysis as a Follow-up Surveillance Tool in Nonmuscle Invasive Bladder Cancer
Minuk Park(박민욱),Bumjin Lim(임범진),Dalsan You(유달산),In Gab Jeong(정인갑),Cheryn Song(송채린),Bumsik Hong(홍범식),Choung-Soo Kim(김청수),Hanjong Ahn(안한종),Jun Hyuk Hong(홍준혁) 대한비뇨기종양학회 2021 대한비뇨기종양학회지 Vol.19 No.4
Purpose: To evaluate the association between microscopic hematuria (MH) detected by surveillance urinalysis and cancer recurrence in nonmuscle invasive bladder cancer (NMIBC) patients. Materials and Methods: A total of 1,082 NMIBC patients who underwent transurethral resection of bladder tumor (TURB) procedures at Asan Medical Center between January 2017 and December 2019 were included. We retrospectively reviewed the follow-up data for these cases including cystoscopy, urinalysis, and urine cytology. The association between urine testing and cancer recurrence was assessed by both univariable and multivariable logistic regression analysis. Results: The study patients had a median age of 68 years (interquartile range, 60–75 years) and comprised 898 men and 184 women. Among the 1,428 TURB procedures conducted in this series, 548 of the lesions (38.4%) were diagnosed as low-grade and 880 (61.6%) as high-grade cancers. A total of 3,309 follow-up cystoscopies were conducted during the study period and were divided into high-grade (HG) (2,011 cases) and low-grade (LG) (1,298 cases) groups according to the latest TURB pathology. MH was found to have a statistically significant association with NMIBC recurrence in both the LG (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.107–2.223; p=0.011) and HG (OR, 1.90; 95% CI, 1.434–2.517; p<0.001) groups. Conclusions: Urinalysis during follow-up may provide important information on cancer recurrence in NMIBC patients.