Second-look transurethral resection in high-grade Ta non-muscle invasive bladder cancer.

Overview

abstract

OBJECTIVE: To evaluate the oncological outcomes of second-look transurethral resection of bladder tumor (TURBT) in patients with a high grade (HG) Ta non-muscle invasive bladder cancer (NMIBC). PATIENTS AND METHODS: We conducted a real-life multicenter study including all consecutive patients with HG Ta NMIBC, with or without second TURBT. Oncological outcomes included disease recurrence and progression. Multivariable Cox regression analyses were used to identify the independent predictors of bladder recurrence and progression. RESULTS: Of the 447 patients with HG Ta NMIBC, 240 (53.7%) underwent a second TURBT, while 207 (46.3%) did not. After a median follow-up of 30 [15-54] months, Kaplan Meier curves showed that a second TURBT was associated with significantly higher 5-year recurrence-free survival (RFS) rate but similar 5-year progression-free survival (PFS) rate. Multivariable Cox regression analysis reported that a second TURBT was not significantly associated with RFS (HR = 0.76; 95% CI=[0.50-1.16]; p = 0.2) and PFS (HR = 0.76; 95% CI=[0.37-1.56]; p = 0.4). Among the 240 patients underwent second TURBT, 151 (63%) had no residual disease. The 5-year RFS and 5-year PFS were significantly higher in patients without residual tumor at second TURBT. Multivariable Cox regression analysis confirmed that residual bladder tumor at second TURBT was the only independent predictor of bladder recurrence (HR = 1.28; p = 0.02) and progression (HR = 1.38; p = 0.03). CONCLUSION: Based on the results of our multicenter retrospective study, a systematic second TURBT in HG Ta NMIBC does not significantly improve oncologic outcomes.