The Optimal Timing of Restaging Resection before Introduction of Bacillus Calmette-Guerin Immunotherapy in Patients with High-Risk Non-Muscle-Invasive Bladder Cancer

Abstract

Introduction: The study aimed to analyze the influence of restaging transurethral resection of bladder tumor (reTURB) timing on outcomes in patients receiving Bacillus Calmette-Guerin (BCG) immunotherapy. Material and Methods: This retrospective study enrolled 491 patients with bladder cancer receiving BCG intravesical therapy between 1998 and 2016. All patients were followed up for at least 12 months and received at least 7 BCG instillations. The patients were analyzed in terms of recurrence free, progression free, and cancer specific survival (CSS). Results: Median follow-up was 57 months (12–257 months). The risk for all analyzed clinical events was higher in patients who underwent reTURB after 6 weeks from primary TURB. After the change point of 57 days after primary resection, further delay was not associated with increased risk of recurrence and progression. The time limit for CSS was 76 days. With every 1 more day of time interval between TURB and reTURB, the risk of each clinical event in follow-up increased by 4%. Conclusions: There is no benefit of the reTURB performed after 8 weeks from primary TURB. Optimal timing of reTURB is from 2 to 6 weeks after initial TURB. However, even within this time frame, the sooner the procedure is performed, the risk of recurrence, progression, or cancer-specific death is lower.

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

“…Nevertheless, our analyses might have underestimated the effect of SLR and similar outcomes in the assessed groups indicate that the patient group subjected to a SLR is associated with worse prognosis and that the SLR per se could be pushing these estimates towards unity. Delayed time to SLR has been proposed to decrease RFS and PFS, if the SLR is performed 6 or 8 wk, respectively, after the primary resection [7,19]. However, as opposed to previous reports, the present study showed no association with time to SLR.…”

“…On the other hand, the effect-size for the SLRintervention in that study on both RFS and PFS is larger than the expected differences for those outcome measures between adjuvant instillations with mitomycin and BCG [4]. The remaining evidence for SLR emanates from retrospective data hampered by studying heterogeneous cohorts, being influenced by selection bias, and also showing conflicting results [5][6][7][8][9][10]. However, some of the series included in that evaluation did not use adjuvant BCG instillations, or even no adjuvant instillations at all, and the largest study assessed did not report progression-free survival, the most important outcome measure in stage T1 BCa.…”

Restaging Transurethral Resection of Bladder Tumours after BCG Immunotherapy Induction in Patients with T1 Non-Muscle-Invasive Bladder Cancer Might not Be Associated with Oncologic Benefit

“…Krajewski et al demonstrated that there is no benefit to reTURB if the procedure is performed eight weeks after the primary TURB and assumed that optimal timing of reTURB is from 2 to 6 weeks after initial TURB. Also, it was shown that each day of reTURB postponement results in a 4% increase in the risk of all analysed clinical events [ 16 ]. Because of this, it might be hypothesized that the time intervals in post-BCG reTURB play a similar role as in conventional reTURB.…”

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

“…Most patients underwent second resection beyond the time frame recommended by the EAU Guidelines and this may result in inferior oncological outcomes [14, 15]. Due to the retrospective study design, specific reasons for delayed reTURBT could not be determined.…”