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, Richard Sylvester, Francesca Pisano, Steven Joniau, Marco Oderda, Vincenzo Serretta, Stéphane Larré, Savino Di Stasi, Bas Van Rhijn, Alfred J Witjes, Anne J Grotenhuis, Renzo Colombo, Alberto Briganti, Marek Babjuk, Viktor Soukup, Per-Uno Malmström, Jacques Irani, Nuria Malats, Jack Baniel, Roy Mano, Tommaso Cai, Eugene K Cha, Peter Ardelt, John Vakarakis, Riccardo Bartoletti, Guido Dalbagni, Shahrokh F Shariat, Evanguelos Xylinas, Robert J Karnes, Joan Palou, Paolo Gontero, Richard Sylvester, Francesca Pisano, Steven Joniau, Marco Oderda, Vincenzo Serretta, Stéphane Larré, Savino Di Stasi, Bas Van Rhijn, Alfred J Witjes, Anne J Grotenhuis, Renzo Colombo, Alberto Briganti, Marek Babjuk, Viktor Soukup, Per-Uno Malmström, Jacques Irani, Nuria Malats, Jack Baniel, Roy Mano, Tommaso Cai, Eugene K Cha, Peter Ardelt, John Vakarakis, Riccardo Bartoletti, Guido Dalbagni, Shahrokh F Shariat, Evanguelos Xylinas, Robert J Karnes, Joan Palou

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.