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Recurrence, progression and cancer-specific mortality according to stage at re-TUR in T1G3 bladder cancer patients treated with BCG: not as bad as previously thought
Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain.
Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain;Osped Citta Salute & Sci Molinette, Dept Urol, Corso Bramante 88, I-10126 Turin, Italy.
EORTC Headquarters, Dept Biostat, Brussels, Belgium.
Univ Hosp Leuven, Oncol & Reconstruct Urol, Dept Urol, Louvain, Belgium.
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2018 (English)In: World journal of urology, ISSN 0724-4983, E-ISSN 1433-8726, Vol. 36, no 10, p. 1621-1627Article in journal (Refereed) Published
Abstract [en]

Purpose: The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis to adequately stage and treat the patient. Persistent disease after TUR is not uncommon and is why re-TUR is recommended in T1G3 patients. When there is T1 tumor in the re-TUR specimen, very high risks of progression (82%) have been reported. We analyze the risks of recurrence, progression to muscle-invasive disease and cancer-specific mortality (CSM) according to tumor stage at re-TUR in T1G3 patients treated with BCG.

Methods: In our retrospective cohort of 2451 T1G3 patients, 934 patients (38.1%) underwent re-TUR. 667 patients had residual disease (71.4%): Ta in 378 (40.5%), T1 in 289 (30.9%) patients. Times to recurrence, progression and CSM in the three groups were estimated using cumulative incidence functions and compared using the Cox regression model.

Results:During a median follow-up of 5.2years, 512 patients recurred. The recurrence rate was significantly higher in patients with a T1 at re-TUR (P<0.001). Progression rates differed according to the pathology at re-TUR, 25.3% in T1, 14.6% in Ta and 14.2% in case of no residual tumor (P<0.001). Similar trends were seen in both patients with and without muscle in the original TUR specimen.

Conclusions: Patients with T1G3 tumors and no residual disease or Ta at re-TUR have better recurrence, progression and CSM rates than previously reported, with a CSM rate of 13.1 and a 25.3% progression rate in re-TUR T1 disease.

Place, publisher, year, edition, pages
SPRINGER , 2018. Vol. 36, no 10, p. 1621-1627
Keywords [en]
Non-muscle invasive bladder cancer, Re-transurethral resection of the bladder, Recurrence, Progression
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:uu:diva-366942DOI: 10.1007/s00345-018-2299-2ISI: 000445121400013PubMedID: 29721611OAI: oai:DiVA.org:uu-366942DiVA, id: diva2:1266566
Available from: 2018-11-28 Created: 2018-11-28 Last updated: 2018-11-28Bibliographically approved

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Malmström, Per-Uno

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