SAN DIEGO, CA USA (UroToday.com) - Drs. Sfakianos, Kim, and Herr from Memorial Sloan Kettering Cancer Center did a retrospective analysis of 1 021 patients with non-muscle invasive bladder cancer (NMIBC) to identify if repeat resection prior to initiation of intravesical BCG improves recurrence-free rates in these patients.
All patients in their cohort underwent a second resection, except for those who were already undergoing BCG treatment at consultation or who refused a repeat resection. Repeat resections were performed within 2-6 weeks after the initial procedure. All patients were followed every 3 to 6 months for a minimum of 5 years. Recurrence was assessed at 3, 6 and 12 months with office cystoscopy, cytology, and resection of bladder tumors when indicated.
12.5% of patients had only a single TUR while 894 (87.5%) had a repeat TUR before intravesical BCG instillation. The median age of the cohort was 63, with 74% being males. At initial presentation they identified 612 (59.9%) and 409 (40.1%) pTa and pT1 tumors, respectively. 769 (75.3%) were high-grade tumors and CIS was found in 629 (61.6%). At repeat TUR, 421 (41.2%) were found to be free of tumor, while 10.7%, 20.7%, 13.5%, and 13.9% were found to have papilloma, pTis only, pTa, and pT1, respectively. On multivariate analysis, presence of tumor on repeat TUR (OR 5.6 95% CI 3.0, 10.2; p < 0.001) and a single TUR (OR 4.4% CI 2.8, 6.9; p < 0.001) were predictors of recurrence at 3 months. On Kaplan-Meier analysis, time to recurrence for a single TUR was significantly decreased compared to those receiving a repeat TUR (median 22 months versus 36 months, p < 0.001).
Authors concluded that repeat TUR prior to initiation of intravesical BCG therapy decreased recurrence rates at 3, 6 and 12 months. This study, along with others, has shown that patients who have had complete resections at the time of TUR, prior to any intravesical therapy or systemic chemotherapy (neoadjuvant), overall have better recurrence-free survival.
Presented by John P. Sfakianos, Philip H. Kim, Harry W. Herr at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Reza Mehrazin, MD