Second-look resection for primary stage T1 bladder cancer: a population-based study

This study aimed to evaluate the use of second-look resection (SLR) in stage T1 bladder cancer (BC) in a population-based Swedish cohort.

All patients diagnosed with stage T1 BC in 2008-2009 were identified in the Swedish National Registry for Urinary Bladder Cancer. Registry data on TNM stage, grade, primary treatment and pathological reports from the SLR performed within 8 weeks of the primary transurethral resection were validated against patient charts. The endpoint was cancer-specific survival (CSS).

In total, 903 patients with a mean age of 74 years (range 28-99 years) were included. SLR was performed in 501 patients (55%), who had the following stages at SLR: 172 (35%) T0, 83 (17%) Ta/Tis, 210 (43%) T1 and 26 (5%) T2-4. The use of SLR varied from 18% to 77% in the six healthcare regions. Multiple adjuvant intravesical instillations were given to 420 patients (47%). SLR was associated with intravesical instillations, age younger than 74 years, discussion at multidisciplinary tumour conference, G3 tumour and treatment at high-volume hospitals. Patients undergoing SLR had a lower risk of dying from BC (hazard ratio 0.62, 95% confidence interval 0.45-0.84, p < .0022). Five-year CSS rates were as follows, in patients with the indicated tumours at SLR (p = .001): 82% in those with T1, 90% in T0, 90% in Ta/Tis and 56% in T2-4.

There are large geographical differences in the use of SLR in stage T1 BC in Sweden, which are presumably related to local treatment traditions. Patients treated with SLR have a high rate of residual tumour but lower age, which suggests that a selection bias affects CSS.

Scandinavian journal of urology. 2017 Apr 11 [Epub ahead of print]

Oliver Patschan, Sten Holmäng, Abolfazl Hosseini, Georg Jancke, Fredrik Liedberg, Börje Ljungberg, Per-Uno Malmström, Johan Rosell, Staffan Jahnson

a Department of Translational Medicine , Lund University and Department of Urology, Skåne University Hospital , Malmö , Sweden., b Department of Urology , Sahlgrenska University Hospital , Göteborg , Sweden., c Department of Urology , Karolinska University Hospital , Stockholm , Sweden., d Department of Surgical and Perioperative Sciences, Urology and Andrology , Umeå University , Umeå , Sweden., e Department of Urology , Akademiska University Hospital , Uppsala , Sweden., f Regional Cancer Center Southeast Sweden and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden., g Department of Urology , University Hospital and IKE, Linköping University , Linköping , Sweden.