High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes: Results of a Multi-Institutional Study

The aim of this multicenter study was to investigate the prognostic impact of residual T1 high-grade (HG)/G3 tumors at re-transurethral resection (TUR of bladder tumor) in a large multi-institutional cohort of patients with primary T1 HG/G3 bladder cancer (BC).

The study period was from January 2002 to -December 2012. A total of 1,046 patients with primary T1 HG/G3 and who had non-muscle invasive BC (NMIBC) on re-TUR followed by adjuvant intravesical Bacillus Calmette-Guerin (BCG) therapy with maintenance were included. Endpoints were time to disease recurrence, progression, and overall and cancer-specific death.

A total of 257 (24.6%) patients had residual T1 HG/G3 tumors. The presence of concomitant carcinoma in situ, multiple and large tumors (> 3 cm) at first TUR were associated with residual T1 HG/G3. Five-year recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were 17% (CI 11.8-23); 58.2% (CI 50.7-65); 73.7% (CI 66.3-79.7); and 84.5% (CI 77.8-89.3), respectively, in patients with residual T1 HG/G3, compared to 36.7% (CI 32.8-40.6); 71.4% (CI 67.3-75.2); 89.8% (CI 86.6-92.3); and 95.7% (CI 93.4-97.3), respectively, in patients with NMIBC other than T1 HG/G3 or T0 tumors. Residual T1 HG/G3 was independently associated with RFS, PFS, OS, and CSS in multivariable analyses.

Residual T1 HG/G3 tumor at re-TUR confers worse prognosis in patients with primary T1 HG/G3 treated with maintenance BCG. Patients with residual T1 HG/G3 for primary T1 HG/G3 are very likely to fail BCG therapy alone.

Urologia internationalis. 2018 Jul 04 [Epub ahead of print]

Matteo Ferro, Mihai Dorin Vartolomei, Francesco Cantiello, Giuseppe Lucarelli, Savino M Di Stasi, Rodolfo Hurle, Giorgio Guazzoni, Gian Maria Busetto, Ettore De Berardinis, Rocco Damiano, Sisto Perdonà, Marco Borghesi, Riccardo Schiavina, Gilberto L Almeida, Pierluigi Bove, Estevao Lima, Giovanni Grimaldi, Riccardo Autorino, Nicolae Crisan, Abdal Rahman Abu Farhan, Paolo Verze, Michele Battaglia, Vincenzo Serretta, Giorgio Ivan Russo, Giuseppe Morgia, Gennaro Musi, Ottavio de Cobelli, Vincenzo Mirone, Shahrokh F Shariat

Division of Urology, European Institute of Oncology, Milan, Italy., Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy., Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy., Department of Experimental Medicine and Surgery, Tor Vegata University, Rome, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Humanitas University, Department of Biomedical Science, Milan, Italy., Department of Urology, Sapienza University of Rome, Rome, Italy., Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale"-IRCCS, Naples, Italy., Department of Urology, University of Bologna, Bologna, Italy., Departamento de Urologia, University of Vale do Itajai, Itajai, Brazil., UOC of Urology Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy., Life and Health Sciences Research Institute, University of Minho, Braga, Portugal., Division of Urology, Virginia Commonwealth University, Richmond, Virginia, USA., Department of Urology, University of Medicine and Pharmacy "Iuliu Hațeganu", Cluj-Napoca, Romania., Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy., Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy., Department of Surgery, Urology Section, University of Catania, Catania, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria.