Article of the Week: Impact of Re-TUR on BCG-Treated T1 HG/G3 Bladder Cancer

Every Week the Editor-in-Chief selects an Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

Finally, the third post under the Article of the Week heading on the homepage will consist of additional material or media. This week we feature a video from Francesca Pisano and Paolo Gontero, discussing their paper.

If you only have time to read one article this week, it should be this one.

The impact of re-transurethral resection on clinical outcomes in a large multicentre cohort of patients with T1 high-grade/Grade 3 bladder cancer treated with bacille Calmette–Guerin

Paolo Gontero¹, Richard Sylvester², Francesca Pisano¹, Steven Joniau³, Marco Oderda¹, Vincenzo Serretta⁴,Stephane Larre⁵, Savino Di Stasi⁶, Bas Van Rhijn⁷, Alfred J.Witjes⁸, Anne J. Grotenhuis⁸, Renzo Colombo⁹, Alberto Briganti⁹, Marek Babjuk¹⁰, Viktor Soukup¹⁰, Per-Uno Malmstrom¹¹, Jacques Irani¹², Nuria Malats¹³, Jack Baniel¹⁴, RoyMano¹⁴, Tommaso Cai¹⁵, Eugene K. Cha¹⁶, Peter Ardelt¹⁷, John Vakarakis¹⁸, Riccardo Bartoletti¹⁹, Guido Dalbagni²⁰, Shahrokh F. Shariat¹⁶, Evanguelos Xylinas¹⁶, Robert J.Karnes²¹and Joan Palou²²

¹Urology Clinic, Citta della Salute e della Scienza di Torino, University of Studies of Turin, Turin ,⁴Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, ⁶Policlinico Tor Vergata-University of Rome, Rome, ⁹Dipartimento di Urologia, Universita Vita-Salute. Ospedale S. Raffaele, Milan, ¹⁵Department of Urology, SantaChiara Hospital, Trento, ¹⁹Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy, ²Formerly Department of Biostatistics, EORTC Headquarters, Brussels, ³Oncologic and Reconstructive Urology, Department of Urology, University Hospitals Leuven, Leuven, Belgium, ⁵Department of Surgical Science, John Radcliffe Hospital, University of Oxford, Oxford, UK, ⁷Department of Urology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, ⁸Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, ¹⁰Department of Urology, Motol Hospital, University of Praha, Praha, Czech Republic, ¹¹Department of Urology, Academic Hospital, Uppsala University, Uppsala, Sweden, ¹²Department of Urology, Centre Hospitalier Universitaire La Miletrie, University of Poitiers, Poitiers, France, ¹³Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, ²²Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain, ¹⁴Department of Urology, Rabin Medical Centre, Tel Aviv, Israel, ¹⁶Department of Urology, Weill Medical College of Cornell University in New York City, ²⁰Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, ²¹Department of Urology, Mayo Clinic, Rochester, MN, USA, ¹⁷Facharzt fur Urologie, Abteilung fur Urologie. Chirurgische Universitats klinik, Freiburg, Germany, and ¹⁸Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece

Read the full article

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.