Prognostic Significance of Residual Tumor at Restaging Transurethral Bladder Resection in High-risk Non-muscle-invasive Bladder Cancer

Overview

Journal World J Urol

Specialty Urology

Date 2024 Aug 12

PMID 39133324

Authors

Alexandre Guigui

Giuseppe Basile

Fabio Zattoni

Andrea Gallioli

Paolo Verri

Julia Aumatell

Bastien Gondran-Tellier

Eric Lechevallier

Cyrille Bastide

Alessandro Uleri

Michele Sica

Thibaut Long-Depaquit

Giuseppe Dinoi

Fabrizio Dal Moro

Akram Akiki

Harry Toledano

Pawel Rajwa

Francesco Montorsi

Daniele Amparore

Francesco Porpiglia

Alberto Breda

Marco Moschini

Michael Baboudjian

Affiliations

Soon will be listed here.

Abstract

Purpose: To assess prognostic significance of residual tumor at repeat transurethral resection (reTUR) in contemporary non-muscle-invasive bladder cancer (NMIBC) patients.

Methods: Patients were identified retrospectively from eight referral centers in France, Italy and Spain. The cohort included consecutive patients with high or very-high risk NMIBC who underwent reTUR and subsequent adjuvant BCG therapy.

Results: A total of 440 high-risk NMIBC patients were screened, 29 (6%) were upstaged ≥ T2 at reTUR and 411 were analyzed (T1 stage: n = 275, 67%). Residual tumor was found in 191 cases (46%). In patients with T1 tumor on initial TURBT, persistent T1 tumor was found in 18% of reTUR (n = 49/275). In patients with high-grade Ta tumor on initial TURBT, T1 tumor was found in 6% of reTUR (n = 9/136). In multivariable logistic regression analysis, we found no statistical association between the use of photodynamic diagnosis (PDD, p = 0.4) or type of resection (conventional vs. en bloc, p = 0.6) and the risk of residual tumor. The estimated 5-yr recurrence and progression-free survival were 56% and 94%, respectively. Residual tumor was significantly associated with a higher risk of recurrence (p < 0.001) but not progression (p = 0.11). Only residual T1 tumor was associated with a higher risk of progression (p < 0.001) with an estimated 5-yr progression-free survival rate of 76%.

Conclusions: ReTUR should remain a standard for T1 tumors, irrespective of the use of en bloc resection or PDD and could be safely omitted in high-grade Ta tumors. Persistent T1 tumor at reTUR should not exclude these patients from conservative management, and further studies are needed to explore the benefit of a third resection in this subgroup.

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