Tumour stage on re-staging transurethral resection predicts recurrence and progression-free survival of patients with high-risk non-muscle invasive bladder cancer

Authors

  • Mohamed Bishr Centre hospitalier de l’Université de Montréal
  • Jean-Baptiste Lattouf Centre hospitalier de l’Université de Montréal
  • Mathieu Latour Centre hospitalier de l’Université de Montréal
  • Fred Saad Centre hospitalier de l’Université de Montréal

DOI:

https://doi.org/10.5489/cuaj.1514

Keywords:

Non-muscle invasive bladder cancer, re-staging transurethral resection, intravesical BCG therapy, recurrence, progression

Abstract

Introduction: To identify patients who should be considered for early radical cystectomy, we evaluated the clinical and pathological variables affecting the outcome of patients with high-risk non-muscle invasive bladder cancer (NMIBC) who underwent re-staging transurethral resection (re-TUR).

Methods: We reviewed the clinical data of 453 patients treated for urothelial carcinoma between 2006 and 2010. In total, 94 patients underwent re-TUR after their initial TUR. Of these, 72 were not upstaged to muscle invasive disease and were therefore included in our study.

Results: On re-TUR, 31 patients had no residual tumour (T0) and 41 patients had residual NMIBC. A statistically significant difference was noted between patients with pT0 and patients with residual NMIBC on re-TUR in regard to tumour recurrence and progression (39% vs. 83%, p < 0.001) (6% vs. 34%, p = 0.005), respectively. On multivariate analysis, tumour stage on re-TUR and the regimen of intravesical bacillus Calmette-Guérin (BCG) therapy (induction vs. maintenance) remained independent predicting factors for recurrence-free survival (RFS) (p = 0.001, hazard ratio [HR]: 1.77), (p < 0.001 HR: 0.16) and progression-free survival (PFS) (p = 0.014, HR: 2.11), (p = 0.008, HR: 0.097), respectively.

Conclusions: The presence of T0 on re-TUR is associated with better RFS and PFS and could be a predictive factor for candidates for conservative management. Patients with persistent NMIBC on re-TUR require close follow-up and, in some cases, could be considered for early cystectomy. Maintenance intravesical BCG therapy can improve RFS and PFS in patients with high-risk NMIBC. This study is limited by its retrospective nature and the relatively small number of patients in the cohort.

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Author Biographies

Mohamed Bishr, Centre hospitalier de l’Université de Montréal

Urology division, Urology resident

 

Jean-Baptiste Lattouf, Centre hospitalier de l’Université de Montréal

Urology divison, professor

Mathieu Latour, Centre hospitalier de l’Université de Montréal

Pathology department, professor

Fred Saad, Centre hospitalier de l’Université de Montréal

Urology division, 

Professor and Chief of Urology

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Published

2014-05-21

How to Cite

Bishr, M., Lattouf, J.-B., Latour, M., & Saad, F. (2014). Tumour stage on re-staging transurethral resection predicts recurrence and progression-free survival of patients with high-risk non-muscle invasive bladder cancer. Canadian Urological Association Journal, 8(5-6), e306–10. https://doi.org/10.5489/cuaj.1514

Issue

Section

Original Research