1654 SECONDARY TRANSURETHRAL RESECTION IS PROTECTIVE AGAINST RECURRENCE AND PROGRESSION FOR PATIENTS WITH T1 BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Superficial1 Apr 20111654 SECONDARY TRANSURETHRAL RESECTION IS PROTECTIVE AGAINST RECURRENCE AND PROGRESSION FOR PATIENTS WITH T1 BLADDER CANCER Eric Umbreit, Mark Shimko, Prabin Thapa, Torrence Wilson, R. Houston Thompson, and Igor Frank Eric UmbreitEric Umbreit Rochester, MN More articles by this author , Mark ShimkoMark Shimko Rochester, MN More articles by this author , Prabin ThapaPrabin Thapa 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.2011.02.1764AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The impact of secondary transurethral resection (TUR) on proper staging and prognosis is established; however, substantially less data has been presented on its ability to prevent future oncologic events. We evaluated the oncologic benefit of secondary transurethral resection (TUR) in patients with newly diagnosed T1 bladder cancer. METHODS We retrospectively studied patients diagnosed with T1 disease between 1995 and 2005 at our institution. The time period encompasses the transition from routine primary TUR-only to routine secondary TUR. Patients were grouped according to whether or not secondary TUR was completed. End-points included persistence (defined as tumor present at first surveillance cystoscopy), recurrence, progression, cancer-specific survival and overall survival. Evaluation used logistic and Cox proportional hazards regression. RESULTS There were 404 patients diagnosed with T1 bladder cancer, of which a single TUR was performed in 267 (66%), 56 (15%) patients underwent immediate cystectomy, and repeat TUR was performed in 141 (35%) patients. Secondary TUR detected residual disease in 83 (59%) patients and 25 (18%) were upstaged to muscle−invasive disease. The median follow−up for survivors was 7.3 years for single TUR and 6.0 years for repeat TUR. Patients who underwent secondary TUR were more likely to be treated after the year 2000 (p=0.002), female (p=0.030), have T1 at original presentation (p<0.001), have high-grade tumor (p=0.007), and less likely to have muscle on original TUR (p=0.015). No difference was noted for CIS, multifocality or tumor size. Persistent disease at first surveillance cystoscopy was noted in 20% (23/116) of patients with secondary TUR vs 35% (93/267) with single TUR (p=0.042). The 5−year recurrence-free and progression-free survival rates were 49% vs 28% (p<0.001) and 87% vs 73% (p=0.013) for secondary TUR vs single TUR, respectively. Cancer-specific and overall survivals were not significantly different between TUR groups. Immediate cystectomy was utilized more often in single TUR patients (18%, 47/267) than secondary TUR patients (6%, 7/116, p<0.001). CONCLUSIONS In an era of transition to routine secondary TUR, secondary TUR not only detected a significant percentage of residual tumors and changed treatment strategy in upstaged cases, but was also associated with a protective benefit against persistence, recurrence and progression. The utilization of early cystectomy in the single TUR patients may account for similar survival between groups. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e664 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Metrics Author Information Eric Umbreit Rochester, MN More articles by this author Mark Shimko Rochester, MN More articles by this author Prabin Thapa 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 ...