Is restaging transurethral resection necessary in patients with non-muscle invasive bladder cancer and limited lamina propria invasion?

Abstract

Objectives To evaluate the influence of lamina propria invasion type at initial transurethral resection (TUR) on re-staging pathology. Materials and Methods We reviewed prospectively-maintained records of all patients with a high-grade pT1 non-muscle invasive bladder cancer (NMIBC) who underwent both initial and restaging TUR within 6 weeks at our center between 2001 and 2016. The pathology of second TUR specimens was analyzed with regard to the characteristics of lamina propria invasion found at initial resection. Results We included 198 patients, with a median age of 70 years (interquartile range: 63–79). Muscle was present in the initial TUR specimen in 107 patients (54%). Pathology restaging was pT0 in 73 patients (37%), pTis in 44 (22%), pTa in 27 (14%), pT1 in 50 (25%) and pT2 in 4 (2%). Eighty-seven patients (44%) had tumors with minimal lamina propria invasion at initial TUR: 53 specimens (27%) had focal invasion (few malignant cells in the lamina propria); 15 specimens (7.6%) had superficial invasion (invasion of the lamina propria to the level of the muscularis mucosae (T1a)); and 19 specimens (10%) had multifocal superficial invasion (multiple areas of T1a). Of the patients with minimal lamina propria invasion, residual disease was found in 54 patients (62%). However, none of those patients had T2 disease. Conclusions A significant number of patients with T1 tumors have residual disease at restaging TUR as do patients with minimal lamina propria invasion. The extent of T1 invasion doesn't eliminate the need for repeat TUR.

Identification of potential prognostic factors for absence of residual disease in the second resection of T1 bladder cancer

“…In our study, one-third of patients had minimal lamina propria invasion, which is comparable to previously published data [12]. The prognostic importance of T1 substaging is currently investigated [13].…”

“…The prognostic importance of T1 substaging is currently investigated [13]. In our cohort, minimal lamina propria invasion was not associated with the second resection outcome, supporting previous findings [12].…”

Does restaging transurethral resection of bladder tumour influence outcomes in patients treated with BCG immunotherapy? 491 cases in 20 years' experience.

“…Bearing in mind the previous reports, the presented results and the risk of tumour underdiagnosis, we believe that T1 cancers with both focal and massive lamina propria infiltration should undergo reTURB [27, 28]. Additionally, because of poor prognosis rates and safety profile of adjuvant procedures, radical treatment should be considered, especially when massive infiltration was found [29–32].…”

High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes: Results of a Multi-Institutional Study

“…On the other hand, Gontero et al [15] reported even a higher rate (30.9%) in a multicenter international study. Recently, a prospective study that included 198 patients with T1 HG/G3 also showed that 1/4 of patients have T1 HG/G3 on re-TUR; they also demonstrated that extent of T1 invasion did not eliminate the need for re-TUR [24].…”