Repeat Transurethral Resection of Muscle-invasive Bladder Cancer Prior to Radical Cystectomy is Prognostic but Not Therapeutic
Materials and Methods: An Institutional Review Board approved review of 657 patients diagnosed with muscle-invasive bladder cancer who underwent radical cystectomy at our institution for clinical stage T2 urothelial carcinoma between 2005 and 2017 was performed. Patients with and without repeat transurethral resection of bladder tumor were matched 1-to-1 by propensity score. Matching was done by age, gender, receipt of neoadjuvant chemotherapy, preoperative hydronephrosis, variant histology, lymphovascular invasion, or carcinoma in situ on index transurethral resection of bladder tumor.
Results: A total of 548 patients with muscle-invasive bladder cancer were included after matching (2 groups of 274 patients). Kaplan-Meier estimates of recurrence-free and overall survival demonstrated no significant difference based upon performance of repeat transurethral resection of bladder tumor (P = 1.0 and P = .3, respectively). When outcomes were stratified by pathology of repeat transurethral resection of bladder tumor specimens, those with pT0 had superior recurrence-free and overall survival compared to those with residual muscle invasive disease (P < .001 and P = .001, respectively). Notably, more than 60% of patients who were pT0 on repeat transurethral resection of bladder tumor had residual disease at the time of radical cystectomy.
Conclusions: Repeat transurethral resection of bladder tumor prior to radical cystectomy, irrespective of receipt of neoadjuvant chemotherapy, was not associated with improved survival outcomes in this propensity score matched muscle-invasive bladder cancer cohort. The absence of residual tumor on pathological evaluation of repeat transurethral resection of bladder tumor specimen was prognostic and was associated with improved survival outcomes. However, a large percentage of patients with pT0 disease on repeat transurethral resection of bladder tumor had residual disease on radical cystectomy pathology.
Kelly K. Bree, Andrea Kokorovic, Mary E. Westerman, Patrick J. Hensley, Nathan A. Brooks, Wei Qiao, Yu Shen, Ashish M. Kamat, Colin P. Dinney, and Neema Navai
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Urology, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada; Department of Urology, Louisiana State University Health Science Center-New Orleans, New Orleans, Louisiana; Department of Urology, University of Kentucky, Lexington, Kentucky; Department of Urology, University of Pittsburgh Medical Center Central Pennsylvania, Harrisburg, Pennsylvania; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas; Division of Surgery, The University of Texas, MD Anderson Cancer Center.
Source: Bree KK et al. Repeat Transurethral Resection of Muscle-invasive Bladder Cancer Prior to Radical Cystectomy is Prognostic but Not Therapeutic. The Journal of Urology. 2023. 209(1):140-149.