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

• Published in: World journal of urology Vol. 36; no. 10; pp. 1621 - 1627
• Main Authors: Palou, J., Pisano, F., Sylvester, R., Joniau, S., Serretta, V., Larré, S., Di Stasi, S., van Rhijn, B., Witjes, A. J., Grotenhuis, A., Colombo, R., Briganti, A., Babjuk, M., Soukup, V., Malmstrom, P. U., Irani, J., Malats, N., Baniel, J., Mano, R., Cai, T., Cha, E. K., Ardelt, P., Varkarakis, J., Bartoletti, R., Dalbagni, G., Shariat, S. F., Xylinas, E., Karnes, R. J., Gontero, P.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2018; Springer Nature B.V
• Subjects: Adjuvants, Immunologic - therapeutic use; Administration, Intravesical; Aged; Bacillus Calmette-Guerin vaccine; BCG; BCG Vaccine - therapeutic use; Bladder cancer; Cancer; Cause of Death; Cystectomy - methods; Disease Progression; Female; Follow-Up Studies; Humans; Invasiveness; Male; Medicine; Medicine & Public Health; Mortality; Neoplasm Recurrence, Local - mortality; Neoplasm Staging; Nephrology; Non-muscle invasive bladder cancer; Oncology; Original Article; Progression; Proportional Hazards Models; Re-transurethral resection of the bladder; Recurrence; Reoperation; Retrospective Studies; Risk factors; Tumors; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - therapy; Urology; Non-muscle invasive bladder cancer; Progression; Recurrence; Re-transurethral resection of the bladder
• ISSN: 0724-4983; 1433-8726; 1433-8726
• DOI: 10.1007/s00345-018-2299-2

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.