The clinical significance of a second transurethral resection for T1 high-grade bladder cancer: Results of a prospective study

Abstract

Purpose: This study was designed to estimate the value of a second transurethral resection of bladder tumor (TURBT) procedure in patients with initially diagnosed T1 high-grade bladder cancer.

Materials and methods: Between August 2009 and January 2013, a total of 29 patients with T1 high-grade bladder cancer prospectively underwent a second TURBT procedure. Evaluation included the presence of previously undetected residual tumor, changes to histopathological staging or grading, and tumor location. Recurrence-free and progression-free survival curves were generated to compare the prognosis between the groups with and without residual lesions by use of the Kaplan-Meier method.

Results: Of 29 patients, 22 patients (75.9%) had residual disease after the second TURBT. Staging was as follows: no tumor, 7 (24.1%); Ta, 5 (17.2%); T1, 6 (20.7%); Tis, 6 (20.7%); Ta+Tis, 1 (3.4%); T1+Tis, 1 (3.4%); and ≥T2, 3 (10.3%). The muscle layer was included in the surgical specimen after the initial TURBT in 24 patients (82.7%). In three patients whose cancer was upstaged to pT2 after the second TURBT, the initial surgical specimen contained the muscle layer. In the group with residual lesions, the 3-year recurrence-free survival and 3-year progression-free survival rates were 50% and 66.9%, respectively, whereas these rates were 68.6% and 68.6%, respectively, in the group without residual lesions. This difference was not statistically significant.

Conclusions: Initial TURBT does not seem to be enough to control T1 high-grade bladder cancer. Therefore, a routine second TURBT procedure should be recommended in patients with T1 high-grade bladder cancer to accomplish adequate tumor resection and to identify patients who may need to undergo prompt cystectomy.

Keywords: Neoplasm invasiveness; Recurrence; Urinary bladder neoplasms.

Fig. 1. (A) Kaplan-Meier curves of recurrence-free survival (RFS) in patients with residual tumor (green) and without residual tumor (blue) at the second transurethral resection of bladder tumor (TURBT). Three-year RFS was 68.6% and 50%, respectively (p=0.5). (B) Kaplan-Meier curves of progression-free survival (PFS) in patients with residual tumor (green) and without residual tumor (blue) at the second TURBT. Three-year PFS was 66.9% and 68.6%, respectively (p=0.976).