Repeat transurethral resection (reTURBT) of muscle invasive bladder cancer prior to radical cystectomy is prognostic but not therapeutic.

We sought to evaluate the impact of repeat TURBT (reTURBT) prior to RC on oncologic outcomes in a contemporary cohort at a tertiary care center.

An IRB approved review of 657 patients diagnosed with muscle-invasive bladder cancer (MIBC) who underwent RC at our institution for clinical stage T2 urothelial carcinoma between 2005 and 2017 was performed. Patients with and without reTURBT were matched one-to-one by propensity score. Matching was done by age, gender, receipt of NAC, pre-operative hydronephrosis, variant histology, lymphovascular invasion(LVI) or carcinoma in situ (CIS) on index TURBT.

A total of 548 patients with MIBC were included after matching (two groups of 274 patients). Kaplan-Meier estimates of recurrence-free (RFS) and overall survival (OS) demonstrated no significant difference based upon performance of reTURBT (p=1.0 and p=0.3, respectively). When outcomes were stratified by pathology of reTURBT specimens, those with pT0 had superior RFS and OS compared to those with residual muscle invasive disease (p<0.001 and p=0.001, respectively). Notably, more than 60% of patients who were pT0 on reTURBT had residual disease at the time of RC.

ReTURBT prior to RC, irrespective of receipt of NAC, was not associated with improved survival outcomes in this propensity score matched MIBC cohort. The absence of residual tumor on pathologic evaluation of reTURBT specimen was prognostic and was associated with improved survival outcomes. However, a large percentage of patients with pT0 disease on reTURBT had residual disease on RC pathology.

The Journal of urology. 2022 Oct 11 [Epub ahead of print]

Kelly K Bree, Andrea Kokorovic, Mary E Westerman, Patrick J Hensley, Nathan A Brooks, Wei Qiao, Yu Shen, Ashish M Kamat, Colin P Dinney, Neema Navai

Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX., Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX.

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