J Palou1, F Pisano2,3, R Sylvester4, S Joniau5, V Serretta6, S Larré7, S Di Stasi8, B van Rhijn9, A J Witjes10, A Grotenhuis10, R Colombo11, A Briganti11, M Babjuk12, V Soukup12, P U Malmstrom13, J Irani14, N Malats15, J Baniel16, R Mano16, T Cai17, E K Cha18, P Ardelt19, J Varkarakis20, R Bartoletti21, G Dalbagni22, S F Shariat23, E Xylinas24, R J Karnes25, P Gontero26. 1. Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain. 2. Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain. francescapisano85@gmail.com. 3. Dept of Urology, Ospedale "Città della Salute e della Scienza-Molinette", Corso Bramante 88, 10126, Turin, Italy. francescapisano85@gmail.com. 4. Department of Biostatistics, EORTC Headquarters, Brussels, Belgium. 5. Oncologic and Reconstructive Urology, Department of Urology, University Hospitals Leuven, Louvain, Belgium. 6. Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy. 7. Department of Surgical Science, John Radcliffe Hospital, University of Oxford, Oxford, UK. 8. Policlinico Tor Vergata-University of Rome, Rome, Italy. 9. Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 10. Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. 11. Dipartimento di Urologia, Università Vita-Salute. Ospedale S. Raffaele, Milan, Italy. 12. Department of Urology, Motol Hospital, University of Praha, Prague, Czech Republic. 13. Department of Urology, Academic Hospital, Uppsala University, Uppsala, Sweden. 14. Department of Urology, Centre Hospitalier Universitaire La Milétrie, University of Poitiers, Poitiers, France. 15. Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain. 16. Department of Urology, Rabin Medical Centre, Tel Aviv, Israel. 17. Department of Urology, Santa Chiara Hospital, Trento, Italy. 18. Department of Urology, Weill Medical College of Cornell University, New York, NY, USA. 19. Facharzt fur Urologie, Abteilung fur Urologie, Chirurgische Universitats klinik, Freiburg, Germany. 20. Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece. 21. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 22. Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 23. Medical University of Vienna, Vienna, Austria. 24. Department of Urology, Cochin Hospital, Paris, France. 25. Department of Urology, Mayo Clinic, Rochester, MN, USA. 26. Dept of Urology, Ospedale "Città della Salute e della Scienza-Molinette", Corso Bramante 88, 10126, Turin, Italy.
Abstract
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.
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.
Entities:
Keywords:
Non-muscle invasive bladder cancer; Progression; Re-transurethral resection of the bladder; Recurrence
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