Repeat TUR before radical cystectomy prognostic, may not improve survival in bladder cancer
Houston, TX: Repeat transurethral resection (reTURBT) in muscle-invasive bladder cancer (MIBC) patients before radical cystectomy (RC) did not improve survival outcomes regardless of the receipt of neoadjuvant chemotherapy (NAC), according to a study published in The Journal of Urology.
Residual tumor absence on pathologic evaluation of the reTURBT specimen was prognostic and was linked with improved survival outcomes. However, many patients with pT0 disease on reTURBT had residual disease on RC pathology.
Neema Navai from the University of Texas MD Anderson Cancer Center, Houston, TX, and colleagues aimed to investigate the impact of repeat TURBT (reTURBT) before RC on oncologic outcomes in a contemporary cohort at a tertiary care center.
For this purpose, the researchers performed an IRB-approved review of 657 patients with a muscle-invasive bladder cancer diagnosis who underwent radical cystectomy at the institution for clinical stage T2 urothelial carcinoma between 2005 and 2017. One-to-one by propensity score matching was done in patients with and without reTURBT. Matching was done by gender, age, pre-operative hydronephrosis, receipt of NAC, variant histology, carcinoma in situ (CIS), or lymphovascular invasion(LVI) on index TURBT.
The study led to the following findings:
· The study included 548 patients with MIBC after matching (two groups of 274 patients).
· Kaplan-Meier estimates of recurrence-free (RFS) and overall survival (OS) showed no significant difference based on the performance of reTURBT.
·Stratifying the outcomes by pathology of reTURBT specimens, those with pT0 had superior RFS and OS compared to those with residual muscle-invasive disease.
· More than 60% of patients who were pT0 on reTURBT notably had the residual disease at the time of RC.
"In this propensity score-matched MIBC cohort, ReTURBT before RC, regardless of receipt of NAC, was not linked with improved survival outcomes," the researchers wrote in their conclusion. "Residual tumor absence on pathologic evaluation of reTURBT specimen was prognostic and was tied to improved survival outcomes."
"Many patients with pT0 disease on reTURBT, however, had residual disease on RC pathology."
Reference:
The study titled "Repeat transurethral resection (reTURBT) of muscle invasive bladder cancer prior to radical cystectomy is prognostic but not therapeutic," was published in The Journal of Urology.
DOI: https://doi.org/10.1097/JU.0000000000003015
