Surgeon has a major impact on long-term recurrence risk in patients with non-muscle invasive bladder cancer

Abstract

IntroductionOne of the factors responsible for the risk of recurrence after complete transurethral resection of the bladder tumor (TURBT) in patients with non-muscle invasive bladder cancer (NMIBC) is the quality of surgery that may vary between individual surgeons. The aim of the study was to evaluate the impact of the surgeon on recurrence-free survival in patients with NMIBC.Material and methodsThe long-term results of a series of consecutive TURBTs performed by five staff urologists at a single institution were retrospectively analyzed. A total of 949 cases of organ-preserving treatment in 784 patients with NMIBC were included in the analysis.ResultsWith the median follow-up of 64.3 months (3–124 months), the 5-year recurrence-free survival rates according to the surgeon were 62.9% (95% CI 56.2–69.7%), 53.6% (95% CI 47.4–59.9%), 51.0% (95% CI 39.6–62.4%), 46.2% (95% CI 36.4–56.0%), and 44.2% (95% CI 36.8–51.7%), respectively (p <0.0001). In the multivariate analysis including all potential risk factors, the individual surgeon was associated with a risk of recurrence with a high degree of statistical significance (p = 0.0013). The between-surgeon differences in the recurrence risk were not that pronounced in less extensive tumors.ConclusionsA surgeon has a significant impact on the risk of recurrence after curative treatment of patients with NMIBC. This effect was observed despite the relatively extensive experience in bladder endoscopic surgery of all of the surgeons and practicing in a setting of one specialized center. These findings should be taken into account while performing and evaluating the results of comparative studies.

Validation of EORTC, CUETO and EAU risk stratification in prediction of recurrence, progression and death of patients with initially non-muscle invasive bladder cancer (NMIBC): a cohort analysis with systematic review.

“…Although we acknowledge that discussed systems could be used for recurrent cases to assess prognosis, importantly, our study did analyze one the survival to the first recurrence. The rationale for this was the significant impact of the individual surgeon on the risk of recurrence after curative treatment of patients with NMIBC, as described earlier by the others, [14] and could aggravate the lead-time bias. This approach was adopted in several similar studies, e.g.…”

Quality of transurethral resection of bladder tumor procedure influenced a phase III trial comparing the effect of KLH and mitomycin C

“…The study design called for TURBT prior to randomizing the patients into each treatment arm. Existing medical literature data suggests that outcome of TURBT with regard to recurrence is significantly influenced by the operative experience of the surgeon [ 4 – 10 ]. The results of this analysis provide additional evidence to the referenced existing medical literature data.…”

“…This suggests that when performing new drug efficacy evaluation studies involving surgery as a prerequisite step, as is the case with bladder cancer, the operative experience of the surgeon [ 10 , 11 ] is an additional important factor for consideration in designing future clinical studies.…”

Absence of detrusor muscle in TUR-BT specimen – can we predict who is at highest risk?

“…The skills level of the endourological surgeon [ 5 , 6 ], completeness of the TUR-BT [ 7 ], but especially capturing of vesical detrusor muscle (DM) [ 3 , 5 , 8 , 9 ] were correlated with better prognosis. Furthermore, the usage of liquid biopsies or biochemical markers have been shown to impact diagnosis and prognosis of bladder cancer patients [ 10 , 11 ].…”