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. 2023 Aug;90(3):482-490.
doi: 10.1177/03915603231181619. Epub 2023 Jun 21.

Clinical and pathological predictors of persistent T1 HG at second resection

Andrea Gobbo  1   2 , Vittorio Fasulo  1   2 , Roberto Contieri  1   2 , Alessandro Uleri  1   2 , Pier Paolo Avolio  1   2 , Nicola Frego  1   2 , Giovanni Lughezzani  1   2 , Cesare Saitta  1   2 , Gianluigi Taverna  1   3 , Matteo Zanoni  3 , Stefano Mancon  1   2 , Piergiuseppe Colombo  1   4 , Marina Valeri  1   4 , Alberto Saita  2 , Massimo Lazzeri  2 , Nicolò M Buffi  1   2 , Rodolfo Hurle  2 , Paolo Casale  2
Affiliations

Clinical and pathological predictors of persistent T1 HG at second resection

Andrea Gobbo et al. Urologia. 2023 Aug.

Abstract

Background: T1 high-grade (HG) non-muscle invasive bladder cancer (NMIBC) has a significant risk of recurrence and progression, and the European Association of Urology recommends a second transurethral resection of the bladder (ReTUR). Stage at ReTUR has been shown to be a reliable predictor of survival, therefore, we sought to assess clinical and pathological predictors associated with the persistence of T1 at ReTUR in our retrospective multicentric cohort.

Methods: This is a retrospective multicentric study of T1 HG patients at transurethral resection of the bladder (TURB) who underwent subsequent ReTUR. All histological samples were sub-classified according to Rete Oncologica Lombarda (ROL) T1 sub-staging system.

Results: One hundred and sixty-six patients were enrolled. Forty-four (26.5%) had T1 HG tumor at ReTUR while 93 (56%) had residual tumor of any stage. Lesion size was significantly greater in T1 HG patients at ReTUR, as well as the prevalence of multifocality. The multivariable logistic regression model showed lesion dimension and multifocality as predictors of T1 HG at ReTUR, after adjusting for significant covariables (CIS and detrusor muscle presence). ROL sub-staging system was not a significant predictor, but ROL2 prevalence was higher in the T1 HG at ReTUR group.

Conclusions: Lesion size and multifocality were independent predictors of T1 HG persistence at ReTUR, and patients at risk should be promptly identified and treated accordingly. Our results could help physicians make patient-tailored decisions by identifying those most likely to benefit from a second resection.

Keywords: Bladder cancer; RE-TUR; T1 HG; T1 substaging; non-muscle invasive bladder cancer.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The figure shows the difference of the dimension of the main lesion at first TURB, see Table 1 for values.
Figure 2.
Figure 2.
The figure shows the distributions of multifocality, presence of muscle layer and presence of CIS at first TURB stratified by T1 HG tumor at ReTUR. See Table 1 for values.
See this image and copyright information in PMC

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