A population-based study on the effect of a routine second-look resection on survival in primary stage T1 bladder cancer

Abstract

Objective: To assess the value of second-look resection (SLR) in stage T1 bladder cancer (BCa) with respect to progression-free survival (PFS), and also the secondary outcomes recurrence-free survival (RFS), bladder-cancer-specific survival (CSS), and cystectomy-free survival (CFS).Patients and methods: The study included 2456 patients diagnosed with stage T1 BCa 2004-2009 with 5-yr follow-up registration in the nationwide Bladder Cancer Data Base Sweden (BladderBaSe). PFS, RFS, CSS, and CFS were evaluated in stage T1 BCa patients with or without routine SLR, using univariate and multivariable Cox regression with adjustment for multiple confounders (age, gender, tumour grade, intravesical treatment, hospital volume, comorbidity, and educational level). Results: SLR was performed in 642 (26%) individuals, and more frequently on patients who were aged < 75 yr, had grade 3 tumours, and had less comorbidity. There was no association between SLR and PFS (hazard ratio [HR] 1.1, confidence interval [CI] 0.85-1.3), RFS (HR 1.0, CI 0.90-1.2), CFS (HR 1.2, CI 0.95-1.5) or CSS (HR 1.1, CI 0.89-1.4). Conclusions: We found similar survival outcomes in patients with and patients without SLR, but our study is likely affected by selection mechanisms. A randomised study defining the role of SLR in stage T1 BCa would be highly relevant to guide current praxis.

The devil is in the selected details: second-look resection in T1 bladder cancer

“…The devil is in the selected details: second-look resection in T1 bladder cancer A Swedish population-based study on the effect of routine second-look resection in stage T1 bladder cancer was published earlier in 2021 [1]. The overall finding of this study is that survival outcomes in a cohort of patients with T1 bladder cancer not undergoing second-look resection were identical to those in a cohort of patients with T1 bladder cancer who routinely underwent second-look resection, as recommended in the guidelines.…”

A new Editorial Team for the Scandinavian Journal of Urology

“…In order to invigorate and diversify the board I have reached out to its members, as well as to potential new board members in the area of uro-oncology and clinical cancer epidemiology, where in particular results from our unique Scandinavian clinical cancer registers are of interest [1][2][3][4][5]. Reviewers are the lifeblood of a scientific journal, and to avoid wearing down our loyal group we will engage additional reviewers.…”

Bladder cancer with secondary muscle invasion – a prognostic dilemma

“…patients with high-risk nmiUCB represents an overtreatment in about two-thirds of patients, who persistently survive without tumor progression under conservative therapy [15,16].…”

“…Secondly, valid parameters predicting later progression to muscle invasion under conservative therapy for high-risk nmiUCB would allow these patients to be referred to curatively intended therapy (RC or radiochemotherapy) already before secMI becomes evident. Intravesical instillations of Bacillus Calmette-Gu erin (BCG) with up to 3 years of maintenance therapy remain the current therapeutic gold standard for patients with high-risk nmiUCB [15]. Alternatives such as device-assisted intravesical chemotherapy, novel topical drug delivery systems, and systemic application of immune checkpoint inhibitors are currently being tested, although results with longer follow-up are pending [15].…”

“…Intravesical instillations of Bacillus Calmette-Gu erin (BCG) with up to 3 years of maintenance therapy remain the current therapeutic gold standard for patients with high-risk nmiUCB [15]. Alternatives such as device-assisted intravesical chemotherapy, novel topical drug delivery systems, and systemic application of immune checkpoint inhibitors are currently being tested, although results with longer follow-up are pending [15]. Overall, according to current European Urology Association guidelines, RC is recommended for patients with nmiUCB in BCG-unresponsive tumors and initially for "Very High Risk (VHR)" tumors [15].…”