1657 RESIDUAL T1 DISEASE ON REPEAT TRANSURETHRAL RESECTION FOR T1 BLADDER CANCER INCREASES RISK OF PROGRESSION

You have accessJournal of UrologyBladder Cancer: Superficial1 Apr 20111657 RESIDUAL T1 DISEASE ON REPEAT TRANSURETHRAL RESECTION FOR T1 BLADDER CANCER INCREASES RISK OF PROGRESSION Mark Shimko, Eric Umbreit, Torrence Wilson, R. Houston Thompson, and Igor Frank Mark ShimkoMark Shimko Rochester, MN More articles by this author , Eric UmbreitEric Umbreit Rochester, MN More articles by this author , Torrence WilsonTorrence Wilson Rochester, MN More articles by this author , R. Houston ThompsonR. Houston Thompson Rochester, MN More articles by this author , and Igor FrankIgor Frank Rochester, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1767AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Our objective was to evaluate whether pathologic stage found on secondary transurethral resection (TUR) predicts recurrence, progression, and overall survival in patients with T1 urothelial carcinoma of the bladder. METHODS 141 patients underwent secondary TUR at our institution between 1995 and 2005 following the initial diagnosis of T1 urothelial carcinoma of the bladder. Patient demographics, clinical characteristics and pathologic variables were analyzed to determine the significance of findings at restaging TUR. Evaluation included Fisher's exact test and the log-rank test to compare Kaplan-Meier survival curves. RESULTS Residual disease was detected in 88/141 (62%) patients and 53/141 (38%) patients had no residual tumor. Ta/Tis, T1 and muscle invasion was detected in 25 (18%), 38 (27%) and 25 (18%) patients, respectively. Patients with tumors > 3 cm and high-grade tumors on initial resection were significantly more likely to have residual T1 (p=0.043 and p=0.012) and muscle invasion (p=0.008 and p=0.047). We found no increased risk of residual tumor in patients with history of non-invasive urothelial carcinoma, as well as CIS or multifocality at T1 diagnosis. The median follow-up for survivors was 7.3 years. Of 107 patients undergoing bladder preservation, 54 (50%) recurred and 14 (13%) progressed. Presence of a non-invasive tumor on re-resection did not increase the risk of recurrence, progression or death compared to pT0 on restaging TUR. Of the 38 patients with residual T1 cancer, 9 (24%) underwent immediate cystectomy. In the remaining 29 patients, 18 (62%) progressed to muscle invasion compared to 6 of 78 (8%) who had stage T0, Tis, or Ta tumor detected on restaging TUR (p=0.005). Despite this, no difference was found in recurrence and survival between these groups. CONCLUSIONS Residual T1 cancer present on re-resection is associated with a clinically significant increased risk of progression to muscle invasion. In these patients, strong consideration should be given to immediate cystectomy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e665 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Shimko Rochester, MN More articles by this author Eric Umbreit Rochester, MN More articles by this author Torrence Wilson Rochester, MN More articles by this author R. Houston Thompson Rochester, MN More articles by this author Igor Frank Rochester, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...