Oncological benefit of re‐resection for T1 bladder cancer: a comparative effectiveness study

Wettstein, Marian S.; Baxter, Nancy N.; Sutradhar, Rinku; Mamdani, Muhammad; Song, Peng; Qadri, Syed R.; Li, Kathy; Liu, Ning; Kwast, Theodorus van der; Hermanns, Thomas; Kulkarni, Girish S.

doi:10.1111/bju.15622

Cited by 7 publications

(5 citation statements)

References 27 publications

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“…In a Canadian population-based retrospective observational cohort study ( n = 7666), Wettstein et al. ( 15 ) also reported that OS and CSS rates were significantly higher in patients who underwent re-TUR during any time of follow-up. Even after adjusting for background variables, re-TUR was significantly correlated with lower overall mortality (HR 0.88, 95% CI 0.81–0.95, P < 0.001), whereas the details of intravesical treatment were not described in their paper.…”

Section: Discussionmentioning

confidence: 98%

The impact of second transurethral resection on survival outcomes in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette–Guérin therapy

Kikuchi,

Abe,

Miyake

et al. 2023

Japanese Journal of Clinical Oncology

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Objective Several guidelines recommended that second transurethral resection should be performed in patients with diagnosis of high-risk non-muscle-invasive bladder cancer. However, therapeutic benefits of second transurethral resection before bacillus Calmette–Guérin intravesical instillation were conflicting amongst previous studies. We investigated the prognostic impact of second transurethral resection before bacillus Calmette–Guérin instillation in high-risk non-muscle-invasive bladder cancer patients. Methods This retrospective study included 3104 non-muscle-invasive bladder cancer patients who received bacillus Calmette–Guérin instillations between 2000 and 2019 at 31 collaborative institutions. Univariate and multivariate Cox proportional hazards models were used to assess the risk factors of intravesical recurrence, disease progression, cancer-specific mortality and overall mortality. Results In the entire population, patients undergoing second transurethral resection (33%, 1026/3104) had a lower risk of intravesical recurrence on univariate analysis (hazard ratio 0.85, 95% confidence interval 0.73–0.98, P = 0.027), although it did not remain significant on multivariate analysis (hazard ratio 0.90, 95% confidence interval 0.76–1.07, P = 0.24). Subgroup analysis revealed that, in pT1 patients (n = 1487), second transurethral resection was significantly correlated with a lower risk of intravesical recurrence on multivariate analysis (hazard ratio 0.80, 95% confidence interval 0.64–1.00, P = 0.048), but lower risks of disease progression (hazard ratio 0.75, 95% confidence interval 0.56–1.00, P = 0.049), cancer-specific mortality (hazard ratio 0.54, 95% confidence interval 0.35–0.85, P = 0.007) and overall mortality (hazard ratio 0.73, 95% confidence interval 0.55–0.97, P = 0.027) on univariate analysis. Conclusions Second transurethral resection confers accurate pathological staging and could be used to safely select good candidates for intravesical bacillus Calmette–Guérin instillation. We further confirm that second transurethral resection could confer an oncological benefit in pT1 bladder cancer patients treated by bacillus Calmette–Guérin instillation, and so strongly recommend second transurethral resection in this patient population.

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Section: Discussionmentioning

confidence: 98%

The impact of second transurethral resection on survival outcomes in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette–Guérin therapy

Kikuchi,

Abe,

Miyake

et al. 2023

Japanese Journal of Clinical Oncology

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“…Indeed, reTUR is recommended for all pT1 BCa in clinical guidelines [3]. More recently, Wettstein et al [7] analysed 2162 patients who underwent reTUR among a total of 7666 patients and found that reported that reTUR was significantly associated with lower overall mortality after adjusting for the effects of all assumed confounders (hazard ratio [HR] 0.88, 95% CI 0.81-0.95; P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a repeat transurethral resection (reTUR) after initial TURBT is recommended in clinical guidelines [ 3 ]. Indeed, several studies have shown that a reTUR significantly improves recurrence‐free survival (RFS) [ 4 , 5 ], progression‐free survival (PFS) and overall survival (OS) in patients with pathological stage T1 (pT1) BCa [ 4 , 5 , 6 , 7 ]. However, not all the published studies agree on the long‐term oncological value of reTUR [ 6 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Do we need repeat transurethral resection after en bloc resection for pathological T1 bladder cancer?

et al. 2022

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To assess the clinical significance of repeat transurethral resection (reTUR) and surgical margin status after en bloc resection of bladder tumour (ERBT) for pathological T1 (pT1) bladder cancer. Patients and MethodsWe retrospectively analysed the record of 106 patients with pT1 high-grade bladder cancer who underwent ERBT between April 2013 and February 2021 at multiple institutions. All specimens were reviewed by a genitourinary pathologist. The primary outcome measures were recurrence-free survival (RFS) and progression-free survival (PFS) between patients with and those without reTUR. We also analysed the predictive value of surgical margin on the likelihood of residual tumour on reTUR. ResultsA reTUR was performed in 50 of the 106 patients. The 2-year RFS and 3-year PFS were comparable between patients who underwent reTUR and those who did not (55.1% vs 59.9%, P = 0.6, 80.6% vs 82.6%, P = 0.6, respectively). No patient was upstaged to pT2 on reTUR. Regarding the surgical margin status, there were no recurrences at the original site in 51 patients with negative horizontal margins. Cox proportional hazard analysis revealed that a positive vertical margin was an independent prognostic factor of worse PFS. On reTUR, six pTa/is residues were detected in patients with a positive horizontal margin, and three pT1 residues were detected in one patient with a positive vertical margin or other adverse pathological features. ConclusionsA reTUR after ERBT for pT1 bladder cancer appears not to improve either recurrence or progression. Surgical margin status affects prognosis and reTUR outcomes. A reTUR can be omitted after ERBT in patients with pT1 bladder cancer and negative margins; for those with positive horizontal or vertical margins, reTUR should remain the standard until proven otherwise.

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“…Therefore, second TUR is recommended within 6 weeks for patients diagnosed with HG T1 BCa and HG Ta BCa without the detrusor muscle in the resected samples 4,5,7 . Previous studies showed second TUR plays beneficial roles in treatment, diagnosis, and oncological prognosis 11,12 …”

Section: Advancements In Surgical Concepts Techniques and Devices For...mentioning

confidence: 99%

Recent advancements in the diagnosis and treatment of non‐muscle invasive bladder cancer: Evidence update of surgical concept, risk stratification, andBCG‐treated disease

et al. 2023

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In the management of non‐muscle invasive bladder cancer (NMIBC), disease progression and long‐term control are determined by the intensity of delivered treatment and surveillance and the cancer cells' biological nature. This requires risk stratification–based postoperative management, such as intravesical instillation of chemotherapy drugs, Bacillus Calmette–Guérin (BCG), and radical cystectomy. Advancements in mechanical engineering, molecular biology, and surgical skills have evolved the clinical management of NMIBC. In this review, we describe the updated evidence and perspectives regarding the following aspects: (1) advancements in surgical concepts, techniques, and devices for transurethral resection of the bladder tumor; (2) advancements in risk stratification tools for NMIBC; and (3) advancements in treatment strategies for BCG‐treated NMIBC. Repeat transurethral resection, en‐bloc transurethral resection, and enhanced tumor visualization, including photodynamic diagnosis and narrow‐band imaging, help reduce residual cancer cells, provide accurate diagnosis and staging, and sensitive detection, which are the first essential steps for cancer cure. Risk stratification should always be updated and improved because the treatment strategy changes over time. The BCG‐treated disease concept has recently diversified to include BCG failure, resistance, refractory, unresponsiveness, exposure, and intolerance. A BCG‐unresponsive disease is an extremely aggressive subset unlikely to respond to a rechallenge with BCG. Numerous ongoing clinical trials aim to develop a future bladder‐sparing approach for very high‐risk BCG‐naïve NMIBC and BCG‐unresponsive NMIBC. The key to improving the quality of patient care lies in the continuous efforts to overcome the clinical limitations of bedside management.

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Oncological benefit of re‐resection for T1 bladder cancer: a comparative effectiveness study

Cited by 7 publications

References 27 publications

The impact of second transurethral resection on survival outcomes in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette–Guérin therapy

The impact of second transurethral resection on survival outcomes in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette–Guérin therapy

Do we need repeat transurethral resection after en bloc resection for pathological T1 bladder cancer?

Recent advancements in the diagnosis and treatment of non‐muscle invasive bladder cancer: Evidence update of surgical concept, risk stratification, andBCG‐treated disease

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