Prognostic significance of residual tumor at restaging transurethral bladder resection in high-risk non-muscle-invasive bladder cancer

期刊论文
发表日期：

2024年8月12日

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Alexandre Guigui,
Giuseppe Basile,
Fabio Zattoni,
Andrea Gallioli,
Paolo Verri,
Julia Aumatell,
Bastien Gondran-Tellier,
Eric Lechevallier,
Cyrille Bastide,
Alessandro Uleri,
Michele Sica,
Thibaut Long-Depaquit,
Giuseppe Dinoi,
Fabrizio Dal Moro,
Akram Akiki,
Harry Toledano,
Pawel Rajwa,
Francesco Montorsi,
Daniele Amparore,
Francesco Porpiglia,
Alberto Breda,
Marco Moschini,
Michael Baboudjian

摘要

Purpose

To assess prognostic significance of residual tumor at repeat transurethral resection (reTUR) in contemporary non-muscle-invasive bladder cancer (NMIBC) patients.

Methods

Patients were identified retrospectively from eight referral centers in France, Italy and Spain. The cohort included consecutive patients with high or very-high risk NMIBC who underwent reTUR and subsequent adjuvant BCG therapy.

Results

A total of 440 high-risk NMIBC patients were screened, 29 (6%) were upstaged ≥ T2 at reTUR and 411 were analyzed (T1 stage: n = 275, 67%). Residual tumor was found in 191 cases (46%). In patients with T1 tumor on initial TURBT, persistent T1 tumor was found in 18% of reTUR (n = 49/275). In patients with high-grade Ta tumor on initial TURBT, T1 tumor was found in 6% of reTUR (n = 9/136). In multivariable logistic regression analysis, we found no statistical association between the use of photodynamic diagnosis (PDD, p = 0.4) or type of resection (conventional vs. en bloc, p = 0.6) and the risk of residual tumor. The estimated 5-yr recurrence and progression-free survival were 56% and 94%, respectively. Residual tumor was significantly associated with a higher risk of recurrence (p < 0.001) but not progression (p = 0.11). Only residual T1 tumor was associated with a higher risk of progression (p < 0.001) with an estimated 5-yr progression-free survival rate of 76%.

Conclusions

ReTUR should remain a standard for T1 tumors, irrespective of the use of en bloc resection or PDD and could be safely omitted in high-grade Ta tumors. Persistent T1 tumor at reTUR should not exclude these patients from conservative management, and further studies are needed to explore the benefit of a third resection in this subgroup.