The prognostic value of routine second transurethral resection in patients with newly diagnosed stage pT1 non-muscle-invasive bladder cancer: results from randomized 10-year extension trial
- 35 Downloads
To evaluate the impact of routine second TUR on the long-term outcome of patients with newly diagnosed stage pT1 non-muscle-invasive bladder cancer (NMIBC)
Material and methods
A total of 210 patients (mean age 62.1 years, 89.5% were males) with stage pT1 NMIBC who underwent first TUR were prospectively randomized into two groups including second TUR (n = 105) and no second TUR (n = 105) groups. Data on recurrence, disease progression, 7-year and 10-year recurrence-free survival (RFS), progression-free survival (PFS) and overall survival (OS) were recorded.
The median follow-up time was 119 months (IQR 65-168). Per-protocol (PP) analysis revealed that compared to patients without second TUR, patients with second TUR had significantly higher 5-year, 7-year and 10-year rates for RFS (59.4%, 57.9% and 54.8% vs. 36.3%, 31.7% and 26.8%, respectively, p < 0.001) and PFS (93.3%, 91.9% and 90.4% vs. 74.0%, 71.4% and 68.5%, respectively, p < 0.001). According to PP and intention-to-treat (ITT) analyses, the 10-year OS rate was significantly higher in patients with second TUR (59.1 vs. 40.8%, p = 0.004). Multivariate analysis revealed that undergoing second TUR (OR 1.661, 95% CI 1.156–2.385, p = 0.006) was an independent determinant of prolonged OS.
In conclusion, these findings indicate the prognostic value of second TUR in stage pT1 NMIBC patients, not only for RFS and PFS advantages but also for the long-term OS advantage. Therefore, second TUR should be routinely performed in all stage pT1 NMIBC patients with life expectancy of at least 10 years, given the positive contribution to all oncological outcomes.
KeywordsBladder cancer Stage pT1 Second TUR Overall survival Long-term prognosis
Carcinoma in situ
Non-muscle-invasive bladder cancer
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Cambier S, Sylvester RJ, Collette L et al (2016) EORTC nomograms and risk groups for predicting recurrence, progression, and disease-specific and overall survival in non-muscle-invasive stage Ta-T1 urothelial bladder cancer patients treated with 1–3 years of maintenance Bacillus Calmette-Guérin. Eur Urol 69:60CrossRefGoogle Scholar
- 7.Divrik RT, Sahin AF, Yildirim U et al (2010) Impact of routine second transurethral resection on the long-term outcome of patients with newly diagnosed pT1 urothelial carcinoma with respect to recurrence, progression rate, and disease-specific survival: a prospective randomised clinical trial. Eur Urol 58:185CrossRefGoogle Scholar
- 9.Eble JN, Sauter G, Epstein JI et al (2004) World Health Organization classification of tumours. Pathology and genetics of tumours of the urinary system and male genital organs. IARC Press, LyonGoogle Scholar
- 14.Vogeli TA, Grimm M-O, Simon X et al (2002) Prospective study to assess repeat transurethral resection in superficial bladder cancer. Urologe A 41:470Google Scholar
- 16.Jakse G, Algaba F, Malmstrom PU et al (2004) A second-look TUR in T1 transitional cell carcinoma: why? Eur Urol 45:539Google Scholar
- 20.Audenet F, Retinger C, Chien C et al (2017) Is restaging transurethral resection necessary in patients with non-muscle invasive bladder cancer and limited lamina propria invasion? Urol Oncol Semin Orig Investig 35:603Google Scholar