Prognostic factors of early second transurethral resection of non-muscle invasive bladder cancer - 10 years of experience of a referral center
Abstract
Introduction: Urothelial bladder cancer invading the submucosal layer (T1) is a tumor with a high risk of progression to invasive disease. In case of pT1 histology or absence of detrusor muscle in the specimen, an early second resection of the bladder tumor (reTUR) is indicated.
According to retrospective studies, the histology finding of reTUR has a prognostic value. The aim of this study is to present the outcomes of second resection at a tertiary referral center.
Methods: In total, 146 patients with non-muscle invasive bladder cancer (NMIBC) were analyzed retrospectively. These patients underwent (the first) transurethral resection of their bladder tumor and an early reTUR between 3/2010 and 2/2021.
Recurrence, progression and cystectomy free survival rates (RFS, PFS, CFS) were calculated using the Kaplan-Meier curves and the correlation of 7 clinical and pathologic factors (age, gender, muscle in specimen, presence of residual tumor and carcinoma in situ in reTUR, intravesical chemotherapy and BCG therapy) was evaluated using univariate and multivariate analyses. Results: Median RFS was 2.15 years, 1-year RFS was 66.9% and 3-year RFS was 43.4%.
One-year and 3-year PFS was 93.5% and 88.4%, respectively. One-year and 3-year CFS was 91.0% and 82.4%, respectively.
Based on the multivariate analysis, presence of any residual tumor in reTUR was a negative prognostic marker for RFS, while intravesical chemotherapy and BCG therapy were positive prognostic markers. Presence of any residual tumor in reTUR was the only negative prognostic marker for PFS and CFS.
Conclusion: The quality of the first resection of bladder tumor as determined by its completeness and presence of detrusor muscle in the histology specimen is the cornerstone of an adequate diagnosis and proper treatment. If an early reTUR is indicated, presence of any residual tumor in the histology specimen is a significant prognostic marker according to our findings.