To evaluate the prognostic impact of T-stage at re-transurethral resection of bladder (TURB) and its utility for refining risk stratification across European Association of Urology 2021 (EAU21) risk groups in patients with T1 high-grade (HG) non-muscle-invasive bladder cancer (NMIBC) treated with adequate Bacillus Calmette-Guérin (BCG).
Retrospective multicentre study including patients with primary or secondary T1HG NMIBC treated with TURB, re-TURB, and adequate BCG between 2007 and 2020 across 28 European academic centres. Patients were stratified according to re-TURB pathological stage (T0, Ta, Tis, T1) and EAU21 risk groups. Kaplan-Meier, Cox regression, and competing-risk methods were used to evaluate recurrence-free survival (RFS), HG-RFS, progression-free survival (PFS), and cancer-specific mortality (CSM). A mixture cure model estimated statistical cure fractions for the overall cohort.
Among 1403 patients, residual disease at re-TURB was identified in 38.8%, including 17.7% with persistent T1. Residual T1 was consistently associated with worse outcomes. Compared with T0/Ta, persistent T1 at re-TURB showed substantially lower 5-year HG-RFS and PFS, with high-grade recurrence in over half of patients and 5-year progression up to 48% in high- and very high-risk groups. The 5-year CSM rose from 6-7% (T0/Ta) to 23% (T1). On multivariable analysis, residual T1 was independently associated with worse HG-RFS (hazard ratio 2.40), PFS (hazard ratio 3.10), and CSM (hazard ratio 3.00). Cure modelling showed lower cure fractions for residual T1 compared with T0/Ta.
Residual T1 at re-TURB is strongly associated with adverse long-term oncological outcomes in BCG-treated T1HG NMIBC and markedly reduces the likelihood of statistical cure. High- and very high-risk patients with persistent T1 represent a biologically adverse subgroup in whom standard BCG may be insufficient.
BJU international. 2026 Mar 03 [Epub ahead of print]
Ana Fernández-Mardomingo, Jose Daniel Subiela, Alberto Artiles Medina, Wojciech Krajewski, Renate Pichler, Nils C H van Creij, María de la Palma de la Estella Lucena, Irene de la Parra, Cesar Mínguez Ojeda, Almudena Coloma, Luis Crespo Martínez, Pedro Del Olmo Durán, Daniel A González-Padilla, Felipe Villacampa, Júlia Aumatell, Pietro Scilipoti, Mattia Longoni, Marco Moschini, Mario de Angelis, Jorge Caño-Velasco, Roberto Contieri, Andrea Gallioli, David D'Andrea, Eduardo Albers Acosta, Tarek Ajami, Elisabeth Grobet-Jeandin, Francesco Del Giudice, Valerio Santarelli, Aleksander Ślusarczyk, Simone Albisinni, Francesco Soria, Laura S Mertens, Karl Tully, Andrea Mari, Félix Guerrero-Ramos, Mario Alvarez-Maestro, Franklin Anagua Melendres, Oscar Buisan, Luca Afferi, Pablo Gajate, Patricia Guerrero, Ana Saiz, Benjamin Pradere, Francisco Javier Burgos Revilla, Young Academic Urologist: Urothelial Carcinoma Working Group
Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain., Department of Minimally Invasive Robotic Urology, Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland., Department of Urology, Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria., Department of Urology, Clínica Universidad de Navarra, Madrid, Spain., Servicio de Urología, Hospital Universitario Rey Juan Carlos, Universidad Rey Juan Carlos Móstoles, Madrid, Spain., Division of Experimental Oncology, Department of Urology, Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, Clínica Universidad de Navarra, Pamplona, Spain., Department of Urology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy., Department of Urology, Fundaciò Puigvert, Autonomous University of Barcelona, Barcelona, Spain., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, La Princesa University Hospital, IIS Princesa, Autonomous University of Madrid, Madrid, Spain., Department of Urology, Hospital Clínic de Barcelona, Barcelona, Spain., Department of Urology, Geneva University Hospitals, Geneva, Switzerland., Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy., Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland., Urology Unit, Department of Surgical Sciences, University of Tor Vergata, Rome, Italy., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany., Unit of Oncologic Minimally-Invasive Urology and Andrology - Careggi Hospital, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy., Departament of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain., Department of Urology, Hospital Universitario La Paz, Madrid, Spain., Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland., Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain., Pathology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain., Department of Urology UROSUD, La Croix Du Sud Hospital, Quint-Fonsegrives, France.