The Impact of Restaging Transurethral Resection of Bladder Tumour on Survival Parameters in T1 Non-Muscle Invasive Bladder Cancer - Systematic Review and Meta-analysis.

T1 high-grade non-muscle invasive bladder cancer (NMIBC) is characterized by a high recurrence rate and progression to muscle-invasive disease in significant number of patients. To overcome limitations of initial transurethral resection of bladder tumour (TURBT), various strategies are proposed in the literature. One of them is the performance of restaging TURBT (re-TURBT). In recent years it has been shown that re-TURBT can provide valuable additional pathologic information. However, its potential effect on survival improvement is debatable and benefits from this procedure have been suggested to be dependent on several clinicopathological factors (e.g. the presence of detrusor muscle in initial TURBT).

A systematic search was conducted within the 3 electronic databases, including Medline, Scopus and Embase. The following outcomes were retrieved: outcome measurements of recurrence-free survival (RFS), progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS), including hazard ratios (HR) and 95% confidence intervals (95 % CI). Initially, main analysis for each outcome (RFS, PFS, CSS, OS) was performed. Subsequently, we conducted subgroup analyses for the following factors: T1 grade, presence of detrusor muscle in initial TURBT and the type of adjuvant intravesical therapy.

Finally, 6 studies with overall 3257 participants were identified for this meta-analysis. The significant impact of re-TURBT on RFS, PFS, CSS and OS was not found in overall analysis that included all patients with T1 bladder tumours. On the other hand, subgroup analyses, including studies reporting cohorts with mixed T1 tumour grading, revealed, that re-TURBT was associated with significantly better RFS, PFS and OS.

This meta-analysis shows that re-TURBT does not improve survival outcomes in patients with T1 tumours, however, results of some particular subgroup analyses indicate its potential positive impact on the subsequent course of the disease. Further, high-quality prospective randomized controlled trials are necessary to make final statement about the therapeutic role of re-TURBT in T1 NMIBC.

Journal of endourology. 2020 Apr 25 [Epub ahead of print]

Wojciech Krajewski, Łukasz Nowak, Sławomir Poletajew, Andrzej Tukiendorf, Marco Moschini, Andrea Mari, Ettore di Trapani, Evanguelos Xylinas, Paweł Kiełb, Marek Wełna, Romuald Zdrojowy

Uniwersytet Medyczny im Piastow Slaskich we Wroclawiu, 49550, Borowska, 213, Wrocław, Wroclaw, Dolnyśląsk, Poland, 50-367; ., Uniwersytet Medyczny im Piastów Śląskich we Wrocławiu, 49550, Urology and Urological Oncology, Borowska 213, Wrocław, Poland, 50-556; ., Warsaw, Poland; ., - Social Medicine Department, Wrocław Medical University, Wrocław, Poland, Wrocław, Poland; ., Luzerner Kantonsspital, 30748, Luzerner Kantonsspital, Luzern, Switzerland, 6000., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Florence, Italy; ., Milan, Italy; ., 2 rue charles tellierparis, France, 75016; ., Wroclaw, Poland; ., Wrocław, Poland; ., Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Wrocław, Poland; .