Abstract
Purpose
A re-transurethral resection of the bladder (re-TURB) is a well-established approach in managing non-muscle invasive bladder cancer (NMIBC) for various reasons: repeat-TURB is recommended for a macroscopically incomplete initial resection, restaging-TURB is required if the first resection was macroscopically complete but contained no detrusor muscle (DM) and second-TURB is advised for all completely resected T1-tumors with DM in the resection specimen. This study assessed the long-term outcomes after repeat-, second-, and restaging-TURB in T1-NMIBC patients.
Methods
Individual patient data with tumor characteristics of 1660 primary T1-patients (muscle-invasion at re-TURB omitted) diagnosed from 1990 to 2018 in 17 hospitals were analyzed. Time to recurrence, progression, death due to bladder cancer (BC), and all causes (OS) were visualized with cumulative incidence functions and analyzed by log-rank tests and multivariable Cox-regression models stratified by institution.
Results
Median follow-up was 45.3 (IQR 22.7–81.1) months. There were no differences in time to recurrence, progression, or OS between patients undergoing restaging (135 patients), second (644 patients), or repeat-TURB (84 patients), nor between patients who did or who did not undergo second or restaging-TURB. However, patients who underwent repeat-TURB had a shorter time to BC death compared to those who had second- or restaging-TURB (multivariable HR 3.58, P = 0.004).
Conclusion
Prognosis did not significantly differ between patients who underwent restaging- or second-TURB. However, a worse prognosis in terms of death due to bladder cancer was found in patients who underwent repeat-TURB compared to second-TURB and restaging-TURB, highlighting the importance of separately evaluating different indications for re-TURB.
Similar content being viewed by others
References
Babjuk M, Burger M, Capoun O et al (2022) European association of urology guidelines on non-muscle-invasive bladder cancer (Ta, T1, and Carcinoma in Situ). Eur Urol 81(1):75–94. https://doi.org/10.1016/j.eururo.2021.08.010[publishedOnlineFirst:2021/09/14]
Divrik RT, Sahin AF, Yildirim U, Altok M, Zorlu F (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(2):185–190. https://doi.org/10.1016/j.eururo.2010.03.007[publishedOnlineFirst:2010/03/23]
Naselli A, Hurle R, Paparella S et al (2018) Role of restaging transurethral resection for T1 non-muscle invasive bladder cancer: a systematic review and meta-analysis. Eur Urol Focus 4(4):558–567. https://doi.org/10.1016/j.euf.2016.12.011[publishedOnlineFirst:2017/07/30]
Eroglu A, Ekin RG, Koc G, Divrik RT (2020) 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. Int J Clin Oncol 25(4):698–704. https://doi.org/10.1007/s10147-019-01581-0[publishedOnlineFirst:2019/11/25]
Grimm MO, Steinhoff C, Simon X, Spiegelhalder P, Ackermann R, Vogeli TA (2003) Effect of routine repeat transurethral resection for superficial bladder cancer: a long-term observational study. J Urol 170(2 Pt 1):433–437. https://doi.org/10.1097/01.ju.0000070437.14275.e0
Cumberbatch MGK, Foerster B, Catto JWF et al (2018) Repeat transurethral resection in non-muscle-invasive bladder cancer: a systematic review. Eur Urol 73(6):925–933. https://doi.org/10.1016/j.eururo.2018.02.014[publishedOnlineFirst:2018/03/11]
Soria F, Marra G, D’Andrea D, Gontero P, Shariat SF (2019) The rational and benefits of the second look transurethral resection of the bladder for T1 high grade bladder cancer. Transl Androl Urol 8(1):46–53. https://doi.org/10.21037/tau.2018.10.19[publishedOnlineFirst:2019/04/13]
Gontero P, Sylvester R, Pisano F et al (2016) 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–Guérin. BJU Int 118(1):44–52. https://doi.org/10.1111/bju.13354[publishedOnlineFirst:2015/10/16]
van Rhijn BWG, Hentschel AE, Bründl J et al (2021) Prognostic value of the WHO1973 and WHO2004/2016 classification systems for grade in primary Ta/T1 non-muscle-invasive bladder cancer: a multicenter European association of urology non-muscle-invasive bladder cancer guidelines panel study. Eur Urol Oncol 4(2):182–191. https://doi.org/10.1016/j.euo.2020.12.002[publishedOnlineFirst:2021/01/12]
Kim LHC, Patel MI (2020) Transurethral resection of bladder tumour (TURB). Transl Androl Urol 9(6):3056–3072. https://doi.org/10.21037/tau.2019.09.38
Brausi M, Collette L, Kurth K et al (2002) Variability in the recurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cell carcinoma of the bladder: a combined analysis of seven EORTC studies. Eur Urol 41(5):523–531. https://doi.org/10.1016/s0302-2838(02)00068-4
Wettstein MS, Pham S, Qadri SR et al (2020) Association between surgical case volume and survival in T1 bladder cancer:a need for centralization of care? Can Urol Assoc J 14(9):E394-401. https://doi.org/10.5489/cuaj.6812
Klän R, Loy V, Huland H (1991) Residual tumor discovered in routine second transurethral resection in patients with stage T1 transitional cell carcinoma of the bladder. J Urol 146(2):316–318. https://doi.org/10.1016/s0022-5347(17)37779-0
Calò B, Chirico M, Fortunato F et al (2019) Is repeat transurethral resection always needed in high-grade t1 bladder cancer? Front Oncol 9:465. https://doi.org/10.3389/fonc.2019.00465[publishedOnlineFirst:2019/06/20]
Contieri R, Lughezzani G, Buffi NM et al (2022) Could we safely avoid a second resection in selected patients with t1 non-muscle-invasive bladder cancer? Preliminary Results of cost-effectiveness study from humanitas new indications for ReTUR (HuNIRe) multicenter prospective trial. Front Oncol 12:879399. https://doi.org/10.3389/fonc.2022.879399[publishedOnlineFirst:20220518]
Novara G, Ficarra V (2010) Does routine second transurethral resection affect the long-term outcome of patients with T1 bladder cancer? Why a flawed randomized controlled trial cannot address the issue. Eur Urol 58(2):193–194. https://doi.org/10.1016/j.eururo.2010.04.012[publishedOnlineFirst:2010/04/27]
Acknowledgements
The present study was conducted under the auspices of the EAU-NMIBC Guidelines Panel. The EAU Guidelines Central Office approved the protocol and appropriate ethical approval was obtained at each site. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no financial or non-financial competing interests to declare that are relevant to the content of this article. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Beijert, I.J., Hentschel, A.E., Bründl, J. et al. Second TURB, restaging TURB or repeat TURB in primary T1 non-muscle invasive bladder cancer: impact on prognosis?. Int Urol Nephrol 56, 1323–1333 (2024). https://doi.org/10.1007/s11255-023-03867-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-023-03867-9