Repeat transurethral resection of bladder tumour predicts but does not improve survival

Repeat transurethral resection of bladder tumour prior to radical cystectomy, regardless of whether or not neoadjuvant chemotherapy is administered, does not seem to improve survival in patients with muscle-invasive bladder cancer, reveals a recent study.

On the other hand, the absence of residual tumour on pathological tests of repeat transurethral resection of bladder tumour specimen aids in prognosis and may even help improve survival outcomes. However, several patients with pT0 disease who underwent repeat resection presented with residual disease on radical cystectomy pathology.

The authors conducted an Institutional Review Board-approved review of 657 patients diagnosed with muscle-invasive bladder cancer who underwent radical cystectomy for clinical stage T2 urothelial carcinoma between 2005 and 2017.

Using propensity score, patients with repeat transurethral resection of bladder tumour were matched 1:1 by age, gender, receipt of neoadjuvant chemotherapy, preoperative hydronephrosis, variant histology, lymphovascular invasion, or carcinoma in situ on index transurethral resection of bladder tumour to those without.

The study involved 548 patients with muscle-invasive bladder cancer after matching (two group of 274 patients). Based on performance of repeat transurethral resection of bladder tumour, no significant difference was seen in Kaplan-Meier estimates of recurrence-free (p=1.0) and overall survival (p=0.3).

When stratifying outcomes by pathology of specimens, patients with pT0 showed better recurrence-free (p<0.001) and overall survival (p=0.001) than those with residual muscle invasive disease. However, more than 60 percent of patients who were pT0 on repeat transurethral resection of bladder tumour had residual disease at the time of radical cystectomy.