The role of complete TURBT before radical cystectomy for organ-confined bladder cancer

Abstract

ObjectiveTo investigate the role of complete transurethral resection of bladder tumor (TURBT) before radical cystectomy.Patients and MethodsPatients who underwent radical cystectomy in our center from January 2008 to December 2018 were retrospectively reviewed. Those with disease >T2N0M0 or positive surgical margin and those who were administrated neoadjuvant/adjuvant chemotherapy or radiotherapy were excluded. Complete TURBT was defined as no visible lesion under endoscopic examination after TURBT, presence of muscle layer in the specimen or no tumor in a specimen separated from the base. Kaplan–Meier and log-rank tests assessed disease-free survival. Logistic and Cox regression analysis were performed to identify potential predictors.ResultsIn total, 236 patients were included, and 207 patients were male. The median age was 61 years old. The median number and size were 1 and 3cm respectively, and maximal pathological T stage was T2 in 94 patients. Complete TURBT was related to tumor size (p=0.041), histological variants (p=0.026) and downstaging (p<0.001). Tumor size, grade and histological variants were independent predictors of complete TURBT. With a median follow-up of 42.7 months, 30 patients experienced recurrence. Age and histological variants were independent predictors of disease-free survival (p=0.027 and 0.041, respectively). Complete TURBT was associated with poor prognosis, however, the result was not significant (p=0.068). Downstaging was not associated with survival outcome.ConclusionsComplete TURBT is related to an increased rate of downstaging before radical cystectomy, and both of these factors did not improve oncological outcomes for patients with organ-confined bladder cancer.