High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes: Results of a Multi-Institutional Study

Matteo Ferro, Mihai Dorin Vartolomei, Francesco Cantiello, Giuseppe Lucarelli, Savino M. Di Stasi, Rodolfo Hurle, Giorgio Guazzoni, Gian Maria Busetto, Ettore De Berardinis, Rocco Damiano, Sisto Perdonà, Marco Borghesi, Riccardo Schiavina, Gilberto L. Almeida, Pierluigi Bove, Estevao Lima, Giovanni Grimaldi, Riccardo Autorino, Nicolae Crisan, Abdal Rahman Abu FarhanPaolo Verze, Michele Battaglia, Vincenzo Serretta, Giorgio Ivan Russo, Giuseppe Morgia, Gennaro Musi, Ottavio de Cobelli, Vincenzo Mirone, Shahrokh F. Shariat

Research output: Contribution to journalArticlepeer-review


Introduction: The aim of this multicenter study was to investigate the prognostic impact of residual T1 high-grade (HG)/G3 tumors at re-transurethral resection (TUR of bladder tumor) in a large multi-institutional cohort of patients with primary T1 HG/G3 bladder cancer (BC). Patients and Methods: The study period was from January 2002 to ­December 2012. A total of 1,046 patients with primary T1 HG/G3 and who had non-muscle invasive BC (NMIBC) on re-TUR followed by adjuvant intravesical Bacillus Calmette-Guerin (BCG) therapy with maintenance were included. Endpoints were time to disease recurrence, progression, and overall and cancer-specific death. Results: A total of 257 (24.6%) patients had residual T1 HG/G3 tumors. The presence of concomitant carcinoma in situ, multiple and large tumors (> 3 cm) at first TUR were associated with residual T1 HG/G3. Five-year recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were 17% (CI 11.8–23); 58.2% (CI 50.7–65); 73.7% (CI 66.3–79.7); and 84.5% (CI 77.8–89.3), respectively, in patients with residual T1 HG/G3, compared to 36.7% (CI 32.8–40.6); 71.4% (CI 67.3–75.2); 89.8% (CI 86.6–92.3); and 95.7% (CI 93.4–97.3), respectively, in patients with NMIBC other than T1 HG/G3 or T0 tumors. Residual T1 HG/G3 was independently associated with RFS, PFS, OS, and CSS in multivariable analyses. Conclusions: Residual T1 HG/G3 tumor at re-TUR confers worse prognosis in patients with primary T1 HG/G3 treated with maintenance BCG. Patients with residual T1 HG/G3 for primary T1 HG/G3 are very likely to fail BCG therapy alone.
Original languageEnglish
Pages (from-to)7-15
Number of pages9
JournalUrologia Internationalis
Publication statusPublished - 2018


  • Bladder cancer
  • High risk
  • High-grade
  • Second look resection
  • Transurethral resection of bladder tumor


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