Introduction & Objectives
The goals of transurethral resection of a bladder tumour (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. Persistent disease after TUR is not uncommon and is the reason why re-TUR is recommended in T1G3 patients. When there is T1 tumour in the re-TUR specimen, very high risks of progression (82%) have been reported1 and therefore cystectomy is considered to be mandatory. We analyse the tumour stage at re-TUR and the risk of recurrence, progression to muscle invasive disease and cancer specific mortality (CSM) in T1G3 patients treated with BCG.
Material & Methods
In our retrospective cohort of 2451 T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available.
There was no residual disease in 267 patients (28.6%) and residual disease in 667 patients (71.4%): Ta in 378 (40.5%) and T1 in 289 (30.9%) patients. 310 patients (33.2%) received more than 6 instillations of BCG. Event rates in the 3 groups were compared using the chi-square statistic on 2 degrees of freedom.
With a median follow up of 5.2 years and a maximum follow up of 18.7 years, the following results were observed:
Residual tumour at re-TUR Recurrence N (%) Progression N (%) CSM N (%)
No residual tumour 112 (41.9) 38 (14.2) 16 ( 6.0)
Ta tumour 193 (51.1) 55 (14.6) 31 ( 8.2)
T1 tumour 207 (71.6) 73 (25.3) 38 (13.1)
P value P < 0.001 P < 0.001 P = 0.01
Similar trends were seen in both patients with and patients without muscle in the original TUR specimen.
Patients with T1G3 tumours treated with BCG and no residual disease or Ta tumour at re-TUR have better recurrence, progression and CSM rates than those with T1 tumour. The 25.3% progression rate of patients with T1 disease after re-TUR is far lower than that previously reported, with a CSM rate of 13.1%.
|Stato di pubblicazione||Published - 2017|