Long-term Outcomes from Re-resection for High-risk Non–muscle-invasive Bladder Cancer: A Potential to Rationalize Use

Abstract

Patients undergoing re-resection after a diagnosis of high-grade non-muscle-invasive bladder cancer had higher disease-specific and overall survival rates due to more accurate diagnosis and appropriate subsequent radical treatment. Re-resection carries greatest benefit to patients with lamina propria invasion at diagnosis.

Recurrence, progression and cancer-specific mortality according to stage at re-TUR in T1G3 bladder cancer patients treated with BCG: not as bad as previously thought

“…Similar progression rates were recently obtained by Gordon et al In their retrospective cohort of 932 patients with highrisk NMIBC, those with T1 disease at re-resection had a risk of progression of 22% [17]. Since these progression rates are not as high as previously reported in the other series, conservative management may still be considered with a very close follow-up in these high-risk patients, deferring radical cystectomy except in case of a high recurrence rate or progression to muscle-invasive disease.…”

“…Our re-TUR population mainly presented multiple and large tumors at first resection; moreover, an incomplete first TUR may have affected the decision to perform a re-TUR. All these aspects make the re-TUR population a selected one [17] and could explain the high rate of residual disease we found in our patients. By the way, rates of residual disease up to 60% were recently showed in a retrospective series of high-risk NMIBC [17].…”

“…All these aspects make the re-TUR population a selected one [17] and could explain the high rate of residual disease we found in our patients. By the way, rates of residual disease up to 60% were recently showed in a retrospective series of high-risk NMIBC [17]. Moreover, a recent review on re-TUR confirmed rates of residual disease ranging from 20 to 71% for T1 tumors [22].…”

The role of the vesical imaging-reporting and data system (VI-RADS) for bladder cancer diagnostics—status quo

“…Letztere zeigen im weiteren Krankheitsverlauf in 20-25 % der Fälle einen Progress zu höheren Tumorstadien [7]. Eine Nachresektion nichtmuskelinvasiver Harnblasenkarzinome mit mittlerer oder hoher Risikokonstellation verbessert die diagnostische Genauigkeit in Bezug auf die Tumordifferenzierung und -ausdehnung [8,9].…”

“…Bei bis zu 25 % aller pT1-Urothelkarzinome kann im TUR-Material kein Muskelgewebe nachgewiesen werden. Dies birgt ein signifikantes Risiko des "Understagings" [9,11]. Die Qualität der TUR ist außerdem abhängig vom Operateur -Residualtumorraten (entsprechend einer inkompletten Tumorresektion) schwanken mit dessen Erfahrung [12].…”