Tumour stage on re-staging transurethral resection predicts recurrence and progression-free survival of patients with high-risk non-muscle invasive bladder cancer

Abstract

Introduction: To identify patients who should be considered for early radical cystectomy, we evaluated the clinical and pathological variables affecting the outcome of patients with high-risk nonmuscle invasive bladder cancer (NMIBC) who underwent re-staging transurethral resection (re-TUR). Methods: We reviewed the clinical data of 453 patients treated for urothelial carcinoma between 2006 and 2010. In total, 94 patients underwent re-TUR after their initial TUR. Of these, 72 were not upstaged to muscle invasive disease and were therefore included in our study. Results: On re-TUR, 31 patients had no residual tumour (T0) and 41 patients had residual NMIBC. A statistically significant difference was noted between patients with pT0 and patients with residual NMIBC on re-TUR in regard to tumour recurrence and progression (39% vs. 83%, p < 0.001) (6% vs. 34%, p = 0.005), respectively. On multivariate analysis, tumour stage on re-TUR and the regimen of intravesical bacillus Calmette-Guérin (BCG) therapy (induction vs. maintenance) remained independent predicting factors for recurrence-free survival (RFS) (p = 0.001, hazard ratio [HR]: 1.77), (p < 0.001 HR: 0.16) and progression-free survival (PFS) (p = 0.014, HR: 2.11), (p = 0.008, HR: 0.097), respectively. Conclusions: The presence of T0 on re-TUR is associated with better RFS and PFS and could be a predictive factor for candidates for conservative management. Patients with persistent NMIBC on re-TUR require close follow-up and, in some cases, could be considered for early cystectomy. Maintenance intravesical BCG therapy can improve RFS and PFS in patients with high-risk NMIBC. This study is limited by its retrospective nature and the relatively small number of patients in the cohort.

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

“…Despite proven reTURB benefits, its timing is not well established. Available literature reveals a wide variation of time oscillating from an immediate to 12 weeks after the primary TURB [7,8]. Recently, Baltaci et al [15] analyzed the effect of the reTURB timing on treatment results, showing that the interval between first and second TURB should be ≤42 days in order to attain lower recurrence and progression rates.…”

“…Clinical guidelines by the European Association of Urology and the American Urological Association recommend reTURB to be performed within 2-6 weeks after primary TURB. However, these recommendations are based on low levels of evidence [7][8][9][10].…”

“…However, despite the well documented reTURB position in NMIBC treatment, reTURB optimal timing remains unsettled. In various publications, wide spectrum of timing ranging from 2 to 12 weeks is presented [7,8]. Clinical guidelines by the European Association of Urology and the American Urological Association recommend reTURB to be performed within 2-6 weeks after primary TURB.…”

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

“…Previous studies already reported higher recurrence (45% [29] to 84% [30]) and progression rates (16% [27] to 76% -includes …”

Significant expression of CHK1 and p53 in bladder urothelial carcinoma as potential therapeutic targets and prognosis

“…Approximately, 75% of the BUC patients present non-muscle-invasive bladder cancer (NMIBC; stage Ta-1). Surgical removal by TUR of bladder tumor is still the major treatment of NMIBC; yet, half of NMIBC patients treated with TUR have a recurrence of the disease and 5-25% progressed to muscle-invasive bladder cancer (MIBC, stage T2 and above) after repeated recurrences (4). Patients with MIBC are at high risk of local invasion and distant metastasis, despite radical cystectomy and pelvic lymph-node dissection, up to 50% of patients still develop tumours at distant sites and exhibit a less favorable prognosis with a 5-year survival of <50% (5,6).…”