INTRODUCTION: We sought to determine if restaging resection prior to initiation of induction intravesical Bacillus Calmette-Guérin improves recurrence-free rates in patients with high-risk non-muscle invasive bladder cancer.
MATERIAL AND METHODS: We retrospectively analyzed data on 1,021 patients treated at our institution with intravesical BCG for non-muscle invasive high-risk bladder cancer. All patients underwent a second resection, except for those already undergoing BCG treatment at the time of initial consultation and those refusing a restaging resection. All patients were assessed every 3 to 12 months for a minimum of 5 years. Univariate and multivariate regression was used to identify predictors of five-year recurrence.
RESULTS: Restaging transurethral resection was performed on 894 (87.5%) patients. At restaging resection, 496 (55.5%) were found to have viable tumor. At 3 months, patients with a single resection had a recurrence rate of 44.3% compared to 9.6% for patients with a restaging resection (p< 0.01). On multivariate analysis, a single TUR ([OR] 2.1, 95% CI 1.3, 3.3; p=0.01) was the only predictor of recurrence at 5 years. Time to recurrence for patients with a single resection was significantly shorter compared to those who underwent restaging resection (median 22 months versus 36 months, p < 0.001).
CONCLUSION: Failure to perform a repeat resection prior to initiation of intravesical BCG therapy for high-risk non-muscle invasive bladder cancer significantly increases the risk of recurrence. We believe restaging resection should therefore be performed prior to initiating BCG therapy for all patients with high-risk non-muscle invasive bladder cancer.
Written by:
Sfakianos JP, Kim PH, Hakimi AA, Herr HW. Are you the author?
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
Reference: J Urol. 2013 Aug 20. pii: S0022-5347(13)05142-2.
doi: 10.1016/j.juro.2013.08.022
PubMed Abstract
PMID: 23973518
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