Skip to main content

Advertisement

SpringerLink
Log in

Recurrence, progression and cancer-specific mortality according to stage at re-TUR in T1G3 bladder cancer patients treated with BCG: not as bad as previously thought

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis to adequately stage and treat the patient. Persistent disease after TUR is not uncommon and is why re-TUR is recommended in T1G3 patients. When there is T1 tumor in the re-TUR specimen, very high risks of progression (82%) have been reported. We analyze the risks of recurrence, progression to muscle-invasive disease and cancer-specific mortality (CSM) according to tumor stage at re-TUR in T1G3 patients treated with BCG.

Methods

In our retrospective cohort of 2451 T1G3 patients, 934 patients (38.1%) underwent re-TUR. 667 patients had residual disease (71.4%): Ta in 378 (40.5%), T1 in 289 (30.9%) patients. Times to recurrence, progression and CSM in the three groups were estimated using cumulative incidence functions and compared using the Cox regression model.

Results

During a median follow-up of 5.2 years, 512 patients recurred. The recurrence rate was significantly higher in patients with a T1 at re-TUR (P < 0.001). Progression rates differed according to the pathology at re-TUR, 25.3% in T1, 14.6% in Ta and 14.2% in case of no residual tumor (P < 0.001). Similar trends were seen in both patients with and without muscle in the original TUR specimen.

Conclusions

Patients with T1G3 tumors and no residual disease or Ta at re-TUR have better recurrence, progression and CSM rates than previously reported, with a CSM rate of 13.1 and a 25.3% progression rate in re-TUR T1 disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Svatek RS, Hollenbeck BK, Holmäng S et al (2014) The economics of bladder cancer: costs and considerations of caring for this disease. Eur Urol 66(2):253–262. https://doi.org/10.1016/j.eururo.2014.01.006

    Article  PubMed  Google Scholar 

  2. Burger M, Catto JWF, Dalbagni G et al (2013) Epidemiology and risk factors of urothelial bladder cancer. Eur Urol 63(2):234–241. https://doi.org/10.1016/j.eururo.2012.07.033

    Article  PubMed  Google Scholar 

  3. Babjuk M, Böhle A, Burger M et al (2017) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71(3):447–461. https://doi.org/10.1016/j.eururo.2016.05.041

    Article  Google Scholar 

  4. Sylvester RJ, Van Der Meijden APM, Oosterlinck W et al (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 49(3):466–475. https://doi.org/10.1016/j.eururo.2005.12.031

    Article  Google Scholar 

  5. Fernandez-Gomez J, Madero R, Solsona E et al (2009) Predicting nonmuscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette–Guerin: the CUETO scoring model. J Urol 182(5):2195–2203. https://doi.org/10.1016/j.juro.2009.07.016

    Article  PubMed  Google Scholar 

  6. Xylinas E, Kent M, Kluth L et al (2013) Accuracy of the EORTC risk tables and of the CUETO scoring model to predict outcomes in non-muscle-invasive urothelial carcinoma of the bladder. Br J Cancer 109(6):1460–1466. https://doi.org/10.1038/bjc.2013.372

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Ramirez-Backhaus M, Dominguez-Escrig J, Collado A, Rubio-Briones J, Solsona E (2012) Restaging transurethral resection of bladder tumour for high-risk stage Ta and T1 bladder cancer. Curr Urol Rep 13(2):109–114. https://doi.org/10.1007/s11934-012-0234-4

    Article  PubMed  Google Scholar 

  8. Bishr M, Lattouf JB, Latour M, Saad F (2014) Tumor stage on re-staging transurethral resection predicts recurrence and progression-free survival of patients with high-risk non-muscle invasive bladder cancer. J Can Urol Assoc 8(5–6):6–10. https://doi.org/10.5489/cuaj.1514

    Article  Google Scholar 

  9. Herr HW, Donat SM (2006) A re-staging transurethral resection predicts early progression of superficial bladder cancer. BJU Int 97(6):1194–1198. https://doi.org/10.1111/j.1464-410X.2006.06145.x

    Article  PubMed  Google Scholar 

  10. Herr HW, Donat SM, Dalbagni G (2007) Can restaging transurethral resection of T1 bladder cancer select patients for immediate cystectomy? J Urol 177(1):75–79. https://doi.org/10.1016/j.juro.2007.08.070

    Article  PubMed  Google Scholar 

  11. Hautmann RE, Volkmer BG, Gust K (2009) Quantification of the survival benefit of early versus deferred cystectomy in high-risk non-muscle invasive bladder cancer (T1G3). World J Urol 27:347–351. https://doi.org/10.1007/s00345-009-0402-4

    Article  PubMed  Google Scholar 

  12. Roghmann F, Trinh Q-D, Braun K et al (2014) Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy. Int J Urol 21(2):143–149. https://doi.org/10.1111/iju.12232

    Article  PubMed  Google Scholar 

  13. Nayak JG, Gore JL, Holt SK, Wright JL, Mossanen M, Dash A (2016) Patient-centered risk stratification of disposition outcomes following radical cystectomy. Urol Oncol Semin Orig Invest 34(5):235.e17–235.e23. https://doi.org/10.1016/j.urolonc.2015.11.012

    Article  Google Scholar 

  14. Gontero P, Sylvester R, Pisano F et al (2016) The impact of re-transurethral resection on clinical outcomes in a large multicentre cohort of patients with T1 high-grade/Grade 3 bladder cancer treated with bacille Calmette–Guérin. BJU Int 118(1):44–52

    Article  Google Scholar 

  15. Dalbagni G, Vora K, Kaag M et al (2009) Platinum priority—bladder cancer clinical outcome in a contemporary series of restaged patients with clinical T1 bladder cancer. Eur Urol 56(6):903–910. https://doi.org/10.1016/j.eururo.2009.07.005

    Article  PubMed  Google Scholar 

  16. Herr HW (2011) Role of re-resection in non-muscle-invasive bladder cancer. Sci World J 11:283–288. https://doi.org/10.1100/tsw.2011.29

    Article  Google Scholar 

  17. Gordon P, Thomas PC, Noon AP et al (2017) Long-term outcomes from re-resection for high risk non muscle invasive bladder cancer: a potential to rationalize use. Eur Urol Focus. https://doi.org/10.1016/j.euf.2017.10.004

    Article  PubMed  Google Scholar 

  18. Gontero P, Sylvester R, Pisano F et al (2015) Platinum—urothelial cancer prognostic factors and risk groups in T1G3 non-muscle-invasive bladder cancer patients initially treated with Bacillus Calmette–Gué rin: results of a retrospective multicenter study of 2451 patients. Eur Urol 7(7):4–8. https://doi.org/10.1016/j.eururo.2014.06.040

    Article  Google Scholar 

  19. Denzinger S, Fritsche H-M, Otto W, Blana A, Wieland W-F, Burger M (2008) Early versus deferred cystectomy for initial high-risk pT1G3 urothelial carcinoma of the bladder: do risk factors define feasibility of bladder-sparing approach? Eur Urol 53(1):146–152. https://doi.org/10.1016/j.eururo.2007.06.030

    Article  PubMed  Google Scholar 

  20. Hautmann RE, Volkmer BG, Gust K (2009) Quantification of the survival benefit of early versus deferred cystectomy in high-risk non-muscle invasive bladder cancer (T1G3). World J Urol 27(3):347–351. https://doi.org/10.1007/s00345-009-0402-4

    Article  PubMed  Google Scholar 

  21. Novotny V, Zastrow S, Koch R, Wirth MP (2012) Radical cystectomy in patients over 70 years of age: impact of comorbidity on perioperative morbidity and mortality. World J Urol 30(6):769–776. https://doi.org/10.1007/s00345-011-0782-0

    Article  PubMed  Google Scholar 

  22. Cumberbatch MGK, Foerster B, Catto JWF (2018) Repeat transurethral resection in non-muscle-invasive bladder cancer: a systematic review. Eur Urol (in press)

Download references

Acknowledgements

The authors declare that the development of the manuscript was not supported by an honorarium, a grant, or any other sources of support, including sponsorship or any material sources of support.

Author information

Author notes

  1. R. Sylvester was formerly with EORTC Headquarters, Brussels, Belgium.

Authors and Affiliations

  1. Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain

    J. Palou & F. Pisano

  2. Dept of Urology, Ospedale “Città della Salute e della Scienza-Molinette”, Corso Bramante 88, 10126, Turin, Italy

    F. Pisano & P. Gontero

  3. Department of Biostatistics, EORTC Headquarters, Brussels, Belgium

    R. Sylvester

  4. Oncologic and Reconstructive Urology, Department of Urology, University Hospitals Leuven, Louvain, Belgium

    S. Joniau

  5. Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy

    V. Serretta

  6. Department of Surgical Science, John Radcliffe Hospital, University of Oxford, Oxford, UK

    S. Larré

  7. Policlinico Tor Vergata-University of Rome, Rome, Italy

    S. Di Stasi

  8. Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    B. van Rhijn

  9. Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    A. J. Witjes & A. Grotenhuis

  10. Dipartimento di Urologia, Università Vita-Salute. Ospedale S. Raffaele, Milan, Italy

    R. Colombo & A. Briganti

  11. Department of Urology, Motol Hospital, University of Praha, Prague, Czech Republic

    M. Babjuk & V. Soukup

  12. Department of Urology, Academic Hospital, Uppsala University, Uppsala, Sweden

    P. U. Malmstrom

  13. Department of Urology, Centre Hospitalier Universitaire La Milétrie, University of Poitiers, Poitiers, France

    J. Irani

  14. Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain

    N. Malats

  15. Department of Urology, Rabin Medical Centre, Tel Aviv, Israel

    J. Baniel & R. Mano

  16. Department of Urology, Santa Chiara Hospital, Trento, Italy

    T. Cai

  17. Department of Urology, Weill Medical College of Cornell University, New York, NY, USA

    E. K. Cha

  18. Facharzt fur Urologie, Abteilung fur Urologie, Chirurgische Universitats klinik, Freiburg, Germany

    P. Ardelt

  19. Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece

    J. Varkarakis

  20. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    R. Bartoletti

  21. Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    G. Dalbagni

  22. Medical University of Vienna, Vienna, Austria

    S. F. Shariat

  23. Department of Urology, Cochin Hospital, Paris, France

    E. Xylinas

  24. Department of Urology, Mayo Clinic, Rochester, MN, USA

    R. J. Karnes

Authors
  1. J. Palou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Pisano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Sylvester
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Joniau
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. V. Serretta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Larré
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Di Stasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. B. van Rhijn
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. J. Witjes
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A. Grotenhuis
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. R. Colombo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. A. Briganti
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. M. Babjuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. V. Soukup
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. P. U. Malmstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. J. Irani
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. N. Malats
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. J. Baniel
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. R. Mano
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. T. Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. E. K. Cha
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. P. Ardelt
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. J. Varkarakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. R. Bartoletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. G. Dalbagni
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. S. F. Shariat
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. E. Xylinas
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. R. J. Karnes
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. P. Gontero
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: JP, FP, PG. Acquisition of data: FP, SJ, VS, SL, SS, BR, AW, AG, RC, AB, MB, VS, PUM, JI, NM, JB, RM, TC, EC, PA, JV, RB, GD, SFS, EX, RJK. Analysis and interpretation of data: RS, PJ, FP. Drafting of the manuscript: FP. Critical revision of the manuscript for important intellectual content: RS, SJ, VS, SL, SS, BR, AW, AG, RC, AB, MB, VS, PUM, JI, NM, JB, RM, TC, EC, PA, JV, RB, GD, SFS, EX, RJK, JP. Statistical analysis: RS. Administrative, technical, or material support: FP. Supervision: JP.

Corresponding author

Correspondence to F. Pisano.

Ethics declarations

Informed consent

For this type of study, informed consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Palou, J., Pisano, F., Sylvester, R. et al. Recurrence, progression and cancer-specific mortality according to stage at re-TUR in T1G3 bladder cancer patients treated with BCG: not as bad as previously thought. World J Urol 36, 1621–1627 (2018). https://doi.org/10.1007/s00345-018-2299-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-018-2299-2

Keywords

Search

Navigation