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Multicenter Study
. 2016 Jul;118(1):44-52.
doi: 10.1111/bju.13354. Epub 2015 Nov 6.

The impact of re-transurethral resection on clinical outcomes in a large multicentre cohort of patients with T1 high-grade/Grade 3 bladder cancer treated with bacille Calmette-Guérin

Paolo Gontero  1 , Richard Sylvester  2 , Francesca Pisano  1 , Steven Joniau  3 , Marco Oderda  1 , Vincenzo Serretta  4 , Stéphane Larré  5 , Savino Di Stasi  6 , Bas Van Rhijn  7 , Alfred J Witjes  8 , Anne J Grotenhuis  8 , Renzo Colombo  9 , Alberto Briganti  9 , Marek Babjuk  10 , Viktor Soukup  10 , Per-Uno Malmström  11 , Jacques Irani  12 , Nuria Malats  13 , Jack Baniel  14 , Roy Mano  14 , Tommaso Cai  15 , Eugene K Cha  16 , Peter Ardelt  17 , John Vakarakis  18 , Riccardo Bartoletti  19 , Guido Dalbagni  20 , Shahrokh F Shariat  16 , Evanguelos Xylinas  16 , Robert J Karnes  21 , Joan Palou  22
Affiliations
Multicenter Study

The impact of re-transurethral resection on clinical outcomes in a large multicentre cohort of patients with T1 high-grade/Grade 3 bladder cancer treated with bacille Calmette-Guérin

Paolo Gontero et al. BJU Int. 2016 Jul.

Abstract

Objectives: To determine if a re-transurethral resection (TUR), in the presence or absence of muscle at the first TUR in patients with T1-high grade (HG)/Grade 3 (G3) bladder cancer, makes a difference in recurrence, progression, cancer specific (CSS) and overall survival (OS).

Patients and methods: In a large retrospective multicentre cohort of 2451 patients with T1-HG/G3 initially treated with bacille Calmette-Guérin, 935 (38%) had a re-TUR. According to the presence or absence of muscle in the specimen of the primary TUR, patients were divided in four groups: group 1 (no muscle, no re-TUR), group 2 (no muscle, re-TUR), group 3 (muscle, no re-TUR) and group 4 (muscle, re-TUR). Clinical outcomes were compared across the four groups.

Results: Re-TUR had a positive impact on recurrence, progression, CSS and OS only if muscle was not present in the primary TUR specimen. Adjusting for the most important prognostic factors, re-TUR in the absence of muscle had a borderline significant effect on time to recurrence [hazard ratio (HR) 0.67, P = 0.08], progression (HR 0.46, P = 0.06), CSS (HR 0.31, P = 0.07) and OS (HR 0.48, P = 0.05). Re-TUR in the presence of muscle in the primary TUR specimen did not improve the outcome for any of the endpoints.

Conclusions: Our retrospective analysis suggests that re-TUR may not be necessary in patients with T1-HG/G3, if muscle is present in the specimen of the primary TUR.

Keywords: T1G3; bladder cancer; high grade; progression; re-TUR; recurrence.

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Conflict of interest statement

Conflicts of Interest: None disclosed.

Figures

Figure 1
Figure 1
Time to recurrence according to the presence or absence of muscle in the primary specimen and whether or not a reTUR was carried out.
Figure 2
Figure 2
Time to progression according to the presence or absence of muscle in the primary specimen and whether or not a reTUR was carried out.
Figure 3
Figure 3
Time to death due to bladder cancer according to the presence or absence of muscle in the primary specimen and whether or not a reTUR was carried out.
Figure 4
Figure 4
Duration of survival according to the presence or absence of muscle in the primary specimen and whether or not a reTUR was carried out.
See this image and copyright information in PMC

Comment in

References

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