Comparison of recurrence rates between transurethral Thulium laser en bloc resection and traditional plasma electrocautery resection in the treatment of non-muscle-invasive bladder cancer
Objective To compare the postoperative recurrence rates between Thulium laser en bloc resection of bladder tumor(ERBT)and traditional transurethral resection of bladder tumor(TURBT)in treating patients with non-muscle invasive bladder cancer(NMIBC).Methods A retrospective analysis was conducted on the clinical data of 1 439 patients with NMIBC who underwent either Thulium laser ERBT or TURBT in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,between January 2010 and March 2024.Among them,201 patients received Thulium laser ERBT,while 1 238 patients underwent TURBT.Propensity score matching(PSM)was employed in a 1:1 ratio to eliminate selection bias due to non-random assignment,ensuring the comparability of clinical baseline data such as gender,age,pathological diagnosis,T stage,tumor grade,tumor size,and tumor number between the two groups.Kaplan-Meier method was used to generate recurrence-free survival curves for the matched groups,and the log-rank test was conducted to compare differences between the groups.Univariate and multivariate Cox regression analyses were performed to identify independent risk factors affecting postoperative recurrence.Results After PSM matching,193 patients were included in each group.There were no statistically significant differences between the two groups in terms of gender(P=0.317),age(P=0.207),pathological type(P=0.756),T stage(P=0.402),tumor grade(P=0.965),tumor size(P=0.821),or number of tumors(P=0.421).The median follow-up time was 16.2(8.0,33.9)months.Excluding patients with non-urothelial tumors such as adenocarcinoma and squamous cell carcinoma,there were 180 cases in the Thulium laser ERBT group and 184 cases in the TURBT group.Survival analysis showed that the postoperative recurrence rate of urothelial carcinoma patients in the Thulium laser ERBT group was lower than that in the TURBT group[20.0％(36/180)vs.38.6％(71/184),P＜0.001].Stratified survival analysis indicated that in patients with tumor diameters ≤30 mm[22.3％(29/130)vs.33.6％(45/134),P=0.017]or＞30 mm[14.0％(7/50)vs.52.0％(26/50),P=0.002],the Thulium laser ERBT group had lower postoperative recurrence rate compared to the TURBT group.Among patients with single tumor,the recurrence rate in the Thulium laser ERBT group was lower than in the TURBT group[10.5％(11/105)vs.31.5％(35/111),P＜0.001].However,among patients with multiple tumors,there was no statistically significant difference in recurrence rates between the Thulium laser ERBT group and the TURBT group[35.7％(25/70)vs.47.9％(34/71),P=0.061].Univariate and multivariate Cox regression analyses indicated that Thulium laser ERBT treatment was an independent protective factor against postoperative recurrence in NMIBC patients(HR=0.44,95％CI0.30-0.66,P＜0.001).Patients with adenocarcinoma(HR=5.85,95％CI2.07-16.51,P＜0.001),squamous cell carcinoma(HR=2.98,95％CI 1.04-8.55,P=0.042),or other types of tumors(HR=2.98,95％CI 1.14-7.75,P=0.026)had higher risks of recurrence.High-grade tumor patients faced increased risks of postoperative recurrence(HR=1.84,95％CI 1.21-2.79,P=0.004).Additionally,tumors＞30 mm had increased risks of postoperative recurrence compared to those ≤30 mm(HR=2.00,95％CI1.31-3.05,P=0.001).Patients with single tumor had significantly reduced risks of postoperative recurrence compared to those with multiple tumors(HR=0.50,95％CI 0.34-0.73,P＜0.001).Conclusions Regardless of tumor diameter(≤30 mm or＞30 mm),Thulium laser ERBT significantly reduces the postoperative recurrence rate in patients with urothelial carcinoma compared to TURBT,with the advantage being more pronounced in patients with single bladder tumor.Additionally,patients with high-grade tumors,tumor diameters＞30 mm,or multiple bladder tumors have higher risk of postoperative recurrence.
Urinary bladder neoplasmsCarcinomaNon-muscle-invasiveThulium laser en bloc resection of bladder tumorTransurethral resection of bladder tumorPropensity score matchingPostoperative recurrence rate
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