Paolo Gontero1, Richard Sylvester2, Francesca Pisano1, Steven Joniau3, Marco Oderda1, Vincenzo Serretta4, Stéphane Larré5, Savino Di Stasi6, Bas Van Rhijn7, Alfred J Witjes8, Anne J Grotenhuis8, Renzo Colombo9, Alberto Briganti9, Marek Babjuk10, Viktor Soukup10, Per-Uno Malmström11, Jacques Irani12, Nuria Malats13, Jack Baniel14, Roy Mano14, Tommaso Cai15, Eugene K Cha16, Peter Ardelt17, John Vakarakis18, Riccardo Bartoletti19, Guido Dalbagni20, Shahrokh F Shariat16, Evanguelos Xylinas16, Robert J Karnes21, Joan Palou22. 1. Urology Clinic, Città della Salute e della Scienza di Torino, University of Studies of Turin, Turin, Italy. 2. Formerly Department of Biostatistics, EORTC Headquarters, Brussels, Belgium. 3. Oncologic and Reconstructive Urology, Department of Urology, University Hospitals Leuven, Leuven, Belgium. 4. Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy. 5. Department of Surgical Science, John Radcliffe Hospital, University of Oxford, Oxford, UK. 6. Policlinico Tor Vergata-University of Rome, Rome, Italy. 7. Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 8. Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. 9. Dipartimento di Urologia, Università Vita-Salute. Ospedale S. Raffaele, Milan, Italy. 10. Department of Urology, Motol Hospital, University of Praha, Praha, Czech Republic. 11. Department of Urology, Academic Hospital, Uppsala University, Uppsala, Sweden. 12. Department of Urology, Centre Hospitalier Universitaire La Milétrie, University of Poitiers, Poitiers, France. 13. Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain. 14. Department of Urology, Rabin Medical Centre, Tel Aviv, Israel. 15. Department of Urology, Santa Chiara Hospital, Trento, Italy. 16. Department of Urology, Weill Medical College of Cornell University in New York City, New York, NY, USA. 17. Facharzt fur Urologie, Abteilung fur Urologie. Chirurgische Universitats klinik, Freiburg, Germany. 18. Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece. 19. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 20. Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 21. Department of Urology, Mayo Clinic, Rochester, MN, USA. 22. Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain.
Abstract
OBJECTIVES: To determine if a re-transurethral resection (TUR), in the presence or absence of muscle at the first TUR in patients with T1-high grade (HG)/Grade 3 (G3) bladder cancer, makes a difference in recurrence, progression, cancer specific (CSS) and overall survival (OS). PATIENTS AND METHODS: In a large retrospective multicentre cohort of 2451 patients with T1-HG/G3 initially treated with bacille Calmette-Guérin, 935 (38%) had a re-TUR. According to the presence or absence of muscle in the specimen of the primary TUR, patients were divided in four groups: group 1 (no muscle, no re-TUR), group 2 (no muscle, re-TUR), group 3 (muscle, no re-TUR) and group 4 (muscle, re-TUR). Clinical outcomes were compared across the four groups. RESULTS: Re-TUR had a positive impact on recurrence, progression, CSS and OS only if muscle was not present in the primary TUR specimen. Adjusting for the most important prognostic factors, re-TUR in the absence of muscle had a borderline significant effect on time to recurrence [hazard ratio (HR) 0.67, P = 0.08], progression (HR 0.46, P = 0.06), CSS (HR 0.31, P = 0.07) and OS (HR 0.48, P = 0.05). Re-TUR in the presence of muscle in the primary TUR specimen did not improve the outcome for any of the endpoints. CONCLUSIONS: Our retrospective analysis suggests that re-TUR may not be necessary in patients with T1-HG/G3, if muscle is present in the specimen of the primary TUR.
OBJECTIVES: To determine if a re-transurethral resection (TUR), in the presence or absence of muscle at the first TUR in patients with T1-high grade (HG)/Grade 3 (G3) bladder cancer, makes a difference in recurrence, progression, cancer specific (CSS) and overall survival (OS). PATIENTS AND METHODS: In a large retrospective multicentre cohort of 2451 patients with T1-HG/G3 initially treated with bacille Calmette-Guérin, 935 (38%) had a re-TUR. According to the presence or absence of muscle in the specimen of the primary TUR, patients were divided in four groups: group 1 (no muscle, no re-TUR), group 2 (no muscle, re-TUR), group 3 (muscle, no re-TUR) and group 4 (muscle, re-TUR). Clinical outcomes were compared across the four groups. RESULTS: Re-TUR had a positive impact on recurrence, progression, CSS and OS only if muscle was not present in the primary TUR specimen. Adjusting for the most important prognostic factors, re-TUR in the absence of muscle had a borderline significant effect on time to recurrence [hazard ratio (HR) 0.67, P = 0.08], progression (HR 0.46, P = 0.06), CSS (HR 0.31, P = 0.07) and OS (HR 0.48, P = 0.05). Re-TUR in the presence of muscle in the primary TUR specimen did not improve the outcome for any of the endpoints. CONCLUSIONS: Our retrospective analysis suggests that re-TUR may not be necessary in patients with T1-HG/G3, if muscle is present in the specimen of the primary TUR.
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