Risk factors for residual disease at re-TUR in a large cohort of T1G3 patients.

The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. It is well known that the presence of detrusor muscle in the specimen is a prerequisite to minimize the risk of under staging. Persistent disease after resection of bladder tumors is not uncommon and is the reason why the European Guidelines recommended a re-TUR for all T1 tumors. It was recently published that when there is muscle in the specimen, re-TUR does not influence progression or cancer specific survival. We present here the patient and tumor factors that may influence the presence of residual disease at re-TUR.

In our retrospective cohort of 2451 primary T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. 74% had multifocal tumors, 20% of tumors were more than 3 cm in diameter and 26% had concomitant CIS. In this subgroup of patients who underwent re-TUR, there was no residual disease in 267 patients (29%) and residual disease in 667 patients (71%): Ta in 378 (40%) and T1 in 289 (31%) patients. Age, gender, tumor status (primary/recurrent), previous intravesical therapy, tumor size, tumor multi-focality, presence of concomitant CIS, and muscle in the specimen were analyzed in order to evaluate risk factors of residual disease at re-TUR, both in univariate analyses and multivariate logistic regressions.

The following were not risk factors for residual disease: age, gender, tumor status and previous intravesical chemotherapy. The following were univariate risk factors for presence of residual disease: no muscle in TUR, multiple tumors, tumors > 3 cm, and presence of concomitant CIS. Due to the correlation between tumor multi-focality and tumor size, the multivariate model retained either the number of tumors or the tumor diameter (but not both), p < 0.001. The presence of muscle in the specimen was no longer significant, while the presence of CIS only remained significant in the model with tumor size, p < 0.001.

The most significant factors for a higher risk of residual disease at re-TUR in T1G3 patients are multifocal tumors and tumors more than 3 cm. Patients with concomitant CIS and those without muscle in the specimen also have a higher risk of residual disease.

Actas urologicas espanolas. 2021 May 12 [Epub ahead of print]

F Pisano, P Gontero, R Sylvester, S Joniau, V Serretta, S Larré, S Di Stasi, B van Rhijn, A Witjes, A Grotenhuis, R Colombo, A Briganti, M Babjuk, V Soukup, P U Malmstrom, J Irani, N Malats, J Baniel, R Mano, T Cai, E Cha, P Ardelt, J Varkarakis, R Bartoletti, G Dalbagni, S F Shariat, E Xylinas, R J Karnes, J Palou

Città della Salute e della Scienza di Torino, University of Studies of Turin; Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain. Electronic address: ., Città della Salute e della Scienza di Torino, University of Studies of Turin., Formerly Department of Biostatistics, EORTC Headquarters., Oncologic and Reconstructive Urology, Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy., Department of Surgical Science, John Radcliffe Hospital, University of Oxford, Oxford, UK., Policlinico Tor Vergata-University of Rome, Rome, Italy., Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands., Dipartimento di Urologia, Università Vita-Salute. Ospedale S. Raffaele, Milan, Italy., Department of Urology, Motol Hospital, University of Praha, Praha, Czech Republic., Department of Urology, Academic Hospital, Uppsala University, Uppsala, Sweden., Department of Urology, Hospital Bicetre, France., Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO)., Department of Urology, Rabin Medical Centre, Tel Aviv, Israel., Department of Urology, Santa Chiara Hospital, Trento, Italy., Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA., University Hospital Basel, Urological University Clinic Basel-Liestal, Basel, Switzerland., Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece., Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Department of Urology, Medical University of Vienna, Vienna, 1190, Austria.Department of Urology, Cochin Hospital, Paris, France., Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain.