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19-11-2023 | Urology - Original Paper

Second TURB, restaging TURB or repeat TURB in primary T1 non-muscle invasive bladder cancer: impact on prognosis?

Authors: Irene J. Beijert, Anouk E. Hentschel, Johannes Bründl, Eva M. Compérat, Karin Plass, Oscar Rodríguez, Jose D. Subiela Henríquez, Virginia Hernández, Enrique de la Peña, Isabel Alemany, Diana Turturica, Francesca Pisano, Francesco Soria, Otakar Čapoun, Lenka Bauerová, Michael Pešl, H. Maxim Bruins, Willemien Runneboom, Sonja Herdegen, Johannes Breyer, Antonin Brisuda, Ana Calatrava, José Rubio-Briones, Maximilian Seles, Sebastian Mannweiler, Judith Bosschieter, Venkata R. M. Kusuma, David Ashabere, Nicolai Huebner, Juliette Cotte, Roberto Contieri, Laura S. Mertens, Francesco Claps, Alexandra Masson-Lecomte, Fredrik Liedberg, Daniel Cohen, Luca Lunelli, Olivier Cussenot, Soha El Sheikh, Dimitrios Volanis, Jean-François Côté, Morgan Rouprêt, Andrea Haitel, Shahrokh F. Shariat, A. Hugh Mostafid, Jakko A. Nieuwenhuijzen, Richard Zigeuner, Jose L. Dominguez-Escrig, Jaromir Hacek, Alexandre R. Zlotta, Maximilian Burger, Matthias Evert, Christina A. Hulsbergen-van de Kaa, Antoine G. van der Heijden, Lambertus A. L. M. Kiemeney, Viktor Soukup, Luca Molinaro, Paolo Gontero, Carlos Llorente, Ferran Algaba, Joan Palou, James N’Dow, Maria J. Ribal, Theo H. van der Kwast, Marko Babjuk, Richard J. Sylvester, Bas W. G. van Rhijn

Published in: International Urology and Nephrology

Abstract

Purpose

A re-transurethral resection of the bladder (re-TURB) is a well-established approach in managing non-muscle invasive bladder cancer (NMIBC) for various reasons: repeat-TURB is recommended for a macroscopically incomplete initial resection, restaging-TURB is required if the first resection was macroscopically complete but contained no detrusor muscle (DM) and second-TURB is advised for all completely resected T1-tumors with DM in the resection specimen. This study assessed the long-term outcomes after repeat-, second-, and restaging-TURB in T1-NMIBC patients.

Methods

Individual patient data with tumor characteristics of 1660 primary T1-patients (muscle-invasion at re-TURB omitted) diagnosed from 1990 to 2018 in 17 hospitals were analyzed. Time to recurrence, progression, death due to bladder cancer (BC), and all causes (OS) were visualized with cumulative incidence functions and analyzed by log-rank tests and multivariable Cox-regression models stratified by institution.

Results

Median follow-up was 45.3 (IQR 22.7–81.1) months. There were no differences in time to recurrence, progression, or OS between patients undergoing restaging (135 patients), second (644 patients), or repeat-TURB (84 patients), nor between patients who did or who did not undergo second or restaging-TURB. However, patients who underwent repeat-TURB had a shorter time to BC death compared to those who had second- or restaging-TURB (multivariable HR 3.58, P = 0.004).

Conclusion

Prognosis did not significantly differ between patients who underwent restaging- or second-TURB. However, a worse prognosis in terms of death due to bladder cancer was found in patients who underwent repeat-TURB compared to second-TURB and restaging-TURB, highlighting the importance of separately evaluating different indications for re-TURB.

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Title: Second TURB, restaging TURB or repeat TURB in primary T1 non-muscle invasive bladder cancer: impact on prognosis?
Authors: Irene J. Beijert
Anouk E. Hentschel
Johannes Bründl
Eva M. Compérat
Karin Plass
Oscar Rodríguez
Jose D. Subiela Henríquez
Virginia Hernández
Enrique de la Peña
Isabel Alemany
Diana Turturica
Francesca Pisano
Francesco Soria
Otakar Čapoun
Lenka Bauerová
Michael Pešl
H. Maxim Bruins
Willemien Runneboom
Sonja Herdegen
Johannes Breyer
Antonin Brisuda
Ana Calatrava
José Rubio-Briones
Maximilian Seles
Sebastian Mannweiler
Judith Bosschieter
Venkata R. M. Kusuma
David Ashabere
Nicolai Huebner
Juliette Cotte
Roberto Contieri
Laura S. Mertens
Francesco Claps
Alexandra Masson-Lecomte
Fredrik Liedberg
Daniel Cohen
Luca Lunelli
Olivier Cussenot
Soha El Sheikh
Dimitrios Volanis
Jean-François Côté
Morgan Rouprêt
Andrea Haitel
Shahrokh F. Shariat
A. Hugh Mostafid
Jakko A. Nieuwenhuijzen
Richard Zigeuner
Jose L. Dominguez-Escrig
Jaromir Hacek
Alexandre R. Zlotta
Maximilian Burger
Matthias Evert
Christina A. Hulsbergen-van de Kaa
Antoine G. van der Heijden
Lambertus A. L. M. Kiemeney
Viktor Soukup
Luca Molinaro
Paolo Gontero
Carlos Llorente
Ferran Algaba
Joan Palou
James N’Dow
Maria J. Ribal
Theo H. van der Kwast
Marko Babjuk
Richard J. Sylvester
Bas W. G. van Rhijn
Publication date: 19-11-2023
Publisher: Springer Netherlands
Published in: International Urology and Nephrology
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-023-03867-9

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