Predictive factors of the absence of residual disease at repeated transurethral resection of the bladder. Is there a possibility to avoid it in well-selected patients?

Francesco Soria, David D'Andrea, Marco Moschini, Andrea Giordano, Simone Mazzoli, Giuseppe Pizzuto, Rodolfo Hurle, Renzo Colombo, Alberto Briganti, Vincenzo Altieri, Shahrokh F. Shariat, Paolo Gontero

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To evaluate the predictive factors of pT0 at repeated transurethral resection of the bladder (re-TURB) in pT1 high-grade (HG) nonmuscle invasive bladder cancer in order to explore the possibility to avoid it in well-selected patients. Methods: This multicenter retrospective study included patients with pT1HG nonmuscle invasive bladder cancer from 4 different centers who underwent a complete TURB. Re-TURB was defined as a second resection which involved the site of the first TURB performed within 2-6 weeks from the previous resection. A multivariable logistic-regression model was performed to evaluate the predictors of pT0 at re-TURB. A nomogram was built to calculate the probability of obtaining a negative histology at re-TURB. The performance of the nomogram and its net benefit were tested with the decision curve analysis. Results: Overall, 321 patients were included in the study. On multivariable logistic regression, detrusor muscle in the specimen (HR 1.99, P = 0.02), concomitant carcinoma in situ (HR 0.29, P = 0.005) and resection performed with en-bloc technique (HR 7.71, P = 0.01) were independent predictors of pT0 at re-TURB. Decision curve analysis showed a net benefit for the nomogram for each probability over 0.35 compared to the strategy to perform a re-TURB in all pT1HG tumors. Conclusions: The presence of detrusor muscle in TURB specimen, the absence of concomitant carcinoma in situ and the en-bloc resection were able to predict a negative histology at re-TURB, opening the door to the possibility to avoid it in an extremely well-selected cohort of patients. External validations and prospective studies are urgently needed.

Original languageEnglish
Pages (from-to)77.e1-77.e7
JournalUrologic Oncology: Seminars and Original Investigations
Volume38
Issue number3
DOIs
Publication statusPublished - Mar 2020

Keywords

  • Nomogram
  • Predictive factors
  • Re-TURB
  • Second look TURB
  • T1HG bladder cancer

ASJC Scopus subject areas

  • Oncology
  • Urology

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