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. 2014 Feb;191(2):341-5.
doi: 10.1016/j.juro.2013.08.022. Epub 2013 Aug 20.

The effect of restaging transurethral resection on recurrence and progression rates in patients with nonmuscle invasive bladder cancer treated with intravesical bacillus Calmette-Guérin

John P Sfakianos  1 , Philip H Kim  2 , A Ari Hakimi  2 , Harry W Herr  2
Affiliations

The effect of restaging transurethral resection on recurrence and progression rates in patients with nonmuscle invasive bladder cancer treated with intravesical bacillus Calmette-Guérin

John P Sfakianos et al. J Urol. 2014 Feb.

Abstract

Purpose: We determined whether restaging resection before initiating induction intravesical bacillus Calmette-Guérin improves the recurrence-free rate in patients with high risk nonmuscle invasive bladder cancer.

Materials and methods: We retrospectively analyzed data on 1,021 patients treated at our institution with intravesical bacillus Calmette-Guérin for nonmuscle invasive high risk bladder cancer. All patients underwent a second resection except those already receiving bacillus Calmette-Guérin at the time of initial consultation and those who refused restaging resection. All patients were assessed every 3 to 12 months for a minimum of 5 years. Univariate and multivariate regression was used to identify predictors of 5-year recurrence.

Results: Restaging transurethral resection was performed in 894 patients (87.5%). At restaging resection viable tumor was found in 496 patients (55.5%). At 3 months patients with a single resection had a 44.3% recurrence rate compared to 9.6% in those with restaging resection (p <0.01). On multivariate analysis a single transurethral resection was the only predictor of recurrence at 5 years (OR 2.1, 95% CI 1.3-3.3, p = 0.01). Time to recurrence in patients with a single resection was significantly shorter than in those with restaging resection (median 22 vs 36 months, p <0.001).

Conclusions: Failure to repeat resection before initiating intravesical bacillus Calmette-Guérin therapy for high risk nonmuscle invasive bladder cancer significantly increases the risk of recurrence. Therefore, we believe that restaging resection should be performed before initiating bacillus Calmette-Guérin therapy in all patients with high risk nonmuscle invasive bladder cancer.

Keywords: BCG; BCG vaccine; CIS; NMIBC; TUR; bacillus Calmette-Guérin; carcinoma; carcinoma in situ; local; neoplasm recurrence; nonmuscle invasive bladder carcinoma; reoperation; transurethral resection; urinary bladder.

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Figures

Figure 1
Figure 1. Percentage of patients with recurrence at 3, 6 and 12 months
(A) Recurrence rates for patients with single or restaging TUR at 3, 6 and 12 months. (B) Recurrence rates for patients with single or restaging TUR at 5 years and at 5 years with exclusion of patients who recurred at 3 months
Figure 2
Figure 2
Kaplan-Meier plot for recurrence-free survival for patients receiving single TUR versus restaging TUR
Figure 3
Figure 3
Kaplan-Meier plot for progression-free survival for patients receiving single TUR vs restaging TUR
See this image and copyright information in PMC

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