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. 2018 Oct;36(10):1621-1627.
doi: 10.1007/s00345-018-2299-2. Epub 2018 May 2.

Recurrence, progression and cancer-specific mortality according to stage at re-TUR in T1G3 bladder cancer patients treated with BCG: not as bad as previously thought

J Palou  1 , F Pisano  2   3 , R Sylvester  4 , S Joniau  5 , V Serretta  6 , S Larré  7 , S Di Stasi  8 , B van Rhijn  9 , A J Witjes  10 , A Grotenhuis  10 , R Colombo  11 , A Briganti  11 , M Babjuk  12 , V Soukup  12 , P U Malmstrom  13 , J Irani  14 , N Malats  15 , J Baniel  16 , R Mano  16 , T Cai  17 , E K Cha  18 , P Ardelt  19 , J Varkarakis  20 , R Bartoletti  21 , G Dalbagni  22 , S F Shariat  23 , E Xylinas  24 , R J Karnes  25 , P Gontero  26
Affiliations

Recurrence, progression and cancer-specific mortality according to stage at re-TUR in T1G3 bladder cancer patients treated with BCG: not as bad as previously thought

J Palou et al. World J Urol. 2018 Oct.

Abstract

Purpose: The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis to adequately stage and treat the patient. Persistent disease after TUR is not uncommon and is why re-TUR is recommended in T1G3 patients. When there is T1 tumor in the re-TUR specimen, very high risks of progression (82%) have been reported. We analyze the risks of recurrence, progression to muscle-invasive disease and cancer-specific mortality (CSM) according to tumor stage at re-TUR in T1G3 patients treated with BCG.

Methods: In our retrospective cohort of 2451 T1G3 patients, 934 patients (38.1%) underwent re-TUR. 667 patients had residual disease (71.4%): Ta in 378 (40.5%), T1 in 289 (30.9%) patients. Times to recurrence, progression and CSM in the three groups were estimated using cumulative incidence functions and compared using the Cox regression model.

Results: During a median follow-up of 5.2 years, 512 patients recurred. The recurrence rate was significantly higher in patients with a T1 at re-TUR (P < 0.001). Progression rates differed according to the pathology at re-TUR, 25.3% in T1, 14.6% in Ta and 14.2% in case of no residual tumor (P < 0.001). Similar trends were seen in both patients with and without muscle in the original TUR specimen.

Conclusions: Patients with T1G3 tumors and no residual disease or Ta at re-TUR have better recurrence, progression and CSM rates than previously reported, with a CSM rate of 13.1 and a 25.3% progression rate in re-TUR T1 disease.

Keywords: Non-muscle invasive bladder cancer; Progression; Re-transurethral resection of the bladder; Recurrence.

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Conflict of interest statement

Conflict of interest

None.

Figures

Fig. 1
Fig. 1
Time to recurrence according to the presence or absence of residual disease at re-TUR and the pathology at re-TUR
Fig. 2
Fig. 2
Time to progression according to the presence or absence of residual disease at re-TUR and the pathology at re-TUR
Fig. 3
Fig. 3
Time to bladder cancer death according to the presence or absence of residual disease at re-TUR and the pathology at re-TUR
See this image and copyright information in PMC

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