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Reducing recurrence in non-muscle-invasive bladder cancer by systematically implementing guideline-based recommendations : effect of a prospective intervention in primary bladder cancer patients

Sörenby, Anne LU ; Baseckas, Gediminas ; Bendahl, Pär Ola LU ; Brändstedt, Johan LU ; Håkansson, Ulf LU ; Nilsson, Stefan ; Patschan, Oliver LU ; Tinzl, Martina LU ; Wokander, Mats and Liedberg, Fredrik LU , et al. (2019) In Scandinavian Journal of Urology 53(2-3). p.109-115
Abstract

Objective: In non-muscle-invasive bladder cancer (NMIBC), local recurrence after transurethral resection of the bladder (TURB) is common. Outcomes vary between urological centres, partly due to the sub-optimal surgical technique and insufficient application of measures recommended in the guidelines. This study evaluated early recurrence rates after primary TURB for NMIBC before and after introducing a standardized treatment protocol. Methods: Medical records of all patients undergoing primary TURB for NMIBC in 2010 at Skåne University Hospital, Malmö, Sweden, were reviewed. A new treatment protocol for NMIBC was defined and introduced in 2013, and results documented during the first year thereafter were compared with those recorded in... (More)

Objective: In non-muscle-invasive bladder cancer (NMIBC), local recurrence after transurethral resection of the bladder (TURB) is common. Outcomes vary between urological centres, partly due to the sub-optimal surgical technique and insufficient application of measures recommended in the guidelines. This study evaluated early recurrence rates after primary TURB for NMIBC before and after introducing a standardized treatment protocol. Methods: Medical records of all patients undergoing primary TURB for NMIBC in 2010 at Skåne University Hospital, Malmö, Sweden, were reviewed. A new treatment protocol for NMIBC was defined and introduced in 2013, and results documented during the first year thereafter were compared with those recorded in 2010 prior to the intervention. The primary endpoint was early recurrence at first control cystoscopy. Comparisons were made by Chi-square analysis and Fisher’s exact test. Recurrence-free survival (RFS) in the two cohorts was also investigated. Results: TURB was performed on 116 and 159 patients before and after the intervention, respectively. The early recurrence rate decreased from 22% to 9.6% (p = 0.005) at the first control cystoscopy after treatment. Residual/Recurrent tumour at the first control cystoscopy after the primary TURB (i.e. at second-look resection or first control cystoscopy) decreased from 31% to 20% (p = 0.038). The proportion of specimens containing muscle in T1 tumours increased from 55% to 94% (p < 0.001). RFS was improved in the intervention group (HR = 0.65, CI = 0.43–1.0; p = 0.05). Conclusions: Introduction of a standardized protocol and reducing the number of surgeons for primary treatment of NMIBC decreased the early recurrence rate from 22% to 9.6% and lowered the recurrence incidence by 35%.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bladder cancer, guideline recommendations, NMIBC, quality of surgery, recurrence, transurethral resection of bladder tumour (TURB)
in
Scandinavian Journal of Urology
volume
53
issue
2-3
pages
109 - 115
publisher
Taylor & Francis
external identifiers
  • pmid:31064253
  • scopus:85065513989
ISSN
2168-1805
DOI
10.1080/21681805.2019.1604568
language
English
LU publication?
yes
id
7a19d298-1843-4690-a40c-75d99491e49a
date added to LUP
2019-05-24 14:30:48
date last changed
2021-06-16 02:47:33
@article{7a19d298-1843-4690-a40c-75d99491e49a,
  abstract     = {<p>Objective: In non-muscle-invasive bladder cancer (NMIBC), local recurrence after transurethral resection of the bladder (TURB) is common. Outcomes vary between urological centres, partly due to the sub-optimal surgical technique and insufficient application of measures recommended in the guidelines. This study evaluated early recurrence rates after primary TURB for NMIBC before and after introducing a standardized treatment protocol. Methods: Medical records of all patients undergoing primary TURB for NMIBC in 2010 at Skåne University Hospital, Malmö, Sweden, were reviewed. A new treatment protocol for NMIBC was defined and introduced in 2013, and results documented during the first year thereafter were compared with those recorded in 2010 prior to the intervention. The primary endpoint was early recurrence at first control cystoscopy. Comparisons were made by Chi-square analysis and Fisher’s exact test. Recurrence-free survival (RFS) in the two cohorts was also investigated. Results: TURB was performed on 116 and 159 patients before and after the intervention, respectively. The early recurrence rate decreased from 22% to 9.6% (p = 0.005) at the first control cystoscopy after treatment. Residual/Recurrent tumour at the first control cystoscopy after the primary TURB (i.e. at second-look resection or first control cystoscopy) decreased from 31% to 20% (p = 0.038). The proportion of specimens containing muscle in T1 tumours increased from 55% to 94% (p &lt; 0.001). RFS was improved in the intervention group (HR = 0.65, CI = 0.43–1.0; p = 0.05). Conclusions: Introduction of a standardized protocol and reducing the number of surgeons for primary treatment of NMIBC decreased the early recurrence rate from 22% to 9.6% and lowered the recurrence incidence by 35%.</p>},
  author       = {Sörenby, Anne and Baseckas, Gediminas and Bendahl, Pär Ola and Brändstedt, Johan and Håkansson, Ulf and Nilsson, Stefan and Patschan, Oliver and Tinzl, Martina and Wokander, Mats and Liedberg, Fredrik and Gudjonsson, Sigurdur},
  issn         = {2168-1805},
  language     = {eng},
  month        = {05},
  number       = {2-3},
  pages        = {109--115},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Urology},
  title        = {Reducing recurrence in non-muscle-invasive bladder cancer by systematically implementing guideline-based recommendations : effect of a prospective intervention in primary bladder cancer patients},
  url          = {http://dx.doi.org/10.1080/21681805.2019.1604568},
  doi          = {10.1080/21681805.2019.1604568},
  volume       = {53},
  year         = {2019},
}