Bladder Cancer: SuperficialMP56-16 THE IMPACT OF RE-TUR ON CLINICAL OUTCOMES IN A LARGE COHORT OF T1G3 PATIENTS TREATED WITH BCG.

You have accessJournal of UrologyBladder Cancer: Superficial1 Apr 2014MP56-16 THE IMPACT OF RE-TUR ON CLINICAL OUTCOMES IN A LARGE COHORT OF T1G3 PATIENTS TREATED WITH BCG. paolo gontero, richard Sylvester, Francesca Pisano, Steven Joniau, Kathy Van der Eeckt, Vincenzo Serretta, Stephane Larrè, Savino Di Stasi, bas van Rhjin, Alfred Witjes, anne grotenhuis, Bart Kimeney, renzo colombo, Alberto Briganti, Marek Babjuk, Viktor soukup, Per Uno Malmstrom, Jaques Irani, Nuria Malats, Jack Baniel, Roy Mano, Tommaso Cai, eugene cha, Peter Ardelt, John varkarakis, Riccardo Bartoletti, Martin Spahn, jouan Palou, Guido Dalbagni, Evangelous Xylinas, Sharok Shariat, and R. Jeffrey karnes paolo gonteropaolo gontero More articles by this author , richard Sylvesterrichard Sylvester More articles by this author , Francesca PisanoFrancesca Pisano More articles by this author , Steven JoniauSteven Joniau More articles by this author , Kathy Van der EecktKathy Van der Eeckt More articles by this author , Vincenzo SerrettaVincenzo Serretta More articles by this author , Stephane LarrèStephane Larrè More articles by this author , Savino Di StasiSavino Di Stasi More articles by this author , bas van Rhjinbas van Rhjin More articles by this author , Alfred WitjesAlfred Witjes More articles by this author , anne grotenhuisanne grotenhuis More articles by this author , Bart KimeneyBart Kimeney More articles by this author , renzo colomborenzo colombo More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Marek BabjukMarek Babjuk More articles by this author , Viktor soukupViktor soukup More articles by this author , Per Uno MalmstromPer Uno Malmstrom More articles by this author , Jaques IraniJaques Irani More articles by this author , Nuria MalatsNuria Malats More articles by this author , Jack BanielJack Baniel More articles by this author , Roy ManoRoy Mano More articles by this author , Tommaso CaiTommaso Cai More articles by this author , eugene chaeugene cha More articles by this author , Peter ArdeltPeter Ardelt More articles by this author , John varkarakisJohn varkarakis More articles by this author , Riccardo BartolettiRiccardo Bartoletti More articles by this author , Martin SpahnMartin Spahn More articles by this author , jouan Paloujouan Palou More articles by this author , Guido DalbagniGuido Dalbagni More articles by this author , Evangelous XylinasEvangelous Xylinas More articles by this author , Sharok ShariatSharok Shariat More articles by this author , and R. Jeffrey karnesR. Jeffrey karnes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1584AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Re-TUR is strongly advocated for T1G3, because of the high incidence residual disease and mainly the risk of substaging. Its real clinical value remains to be determined and the clinical factors that may influence the decision. Some authors suggest that when muscle is present in the specimen, re-TUR may be avoided. To evaluate if the presence of muscle or not at the first TUR in T1G3 bladder cancer makes a difference in recurrence, progression and cancer specific survival after re-TUR. Methods In a large retrospective cohort of 2530 primary T1G3 initially treated with BCG, 953 (37.7%) had a re-TUR. According to the presence or not of muscle in the specimen of primary TUR, patients were divided in 4 groups: group 1 (no muscle, no re-TUR), group 2 (no muscle, re-TUR), group 3 (muscle, no re-TUR) and group 4 (muscle, re-TUR). Clinical outcomes were compared across the 4 groups. Results Table 1 shows the distribution of prognostic factors and clinical outcomes across the 4 groups. Large tumours and multifocal tumours were more likely to have received a re-TUR independent of whether or not the primary specimen contained muscle. Re-TUR had a significant impact on progression, cancer specific (CSS) and overall survival (OS) only when muscle was not present in the primary specimen. When adjusting for the most important prognostic factors including age, tumour size and the presence of CIS, re-TUR in the absence of muscle maintained a positive impact on time to progression (HR 0.44, p=0.048), CSS (HR 0.31; p=0.067), and OS (HR 0.50; p=0.060) and showed a borderline effect on time to first recurrence (HR 0.69; p=0.100). Re-TUR in presence of muscle in the primary specimen did not improve the outcome for any of the endpoints after adjusting for prognostic factors. Conclusions Our retrospective analysis shows that re-TUR may not be mandatory in T1G3 patients when muscle is present in the specimen of the primary TUR. Variable No muscle, no reTUR (group 1) N=134 No muscle, reTUR (group 2) N=277 Muscle, no reTUR (group 3) N=1,127 Muscle, reTUR (group 4) N=640 ∗P1 ∗∗P2 Age - <70 - ≥ 70 74 (6.1) 60 (6.2) 173 (14.3) 104 (10.8) 599 (49.4) 528 (54.7) 367 (30.3) 273 (28.3) 0.161 0.089 Tumour St -Primary -Recurrent 113 (5.8) 21 (8.8) 245 (12.6) 32 (13.5) 993 (51.2) 134 (56.3) 589 (30.4) 51 (21.4) 0.243 0.010 Tumour -Single -Multiple 49 (5.9) 49 (3.8) 35 (4.2) 239 (18.6) 556 (67.4) 554 (43.0) 185 (22.4) 446 (34.6) < 0.001 < 0.001 Size - < 3 cm - ≥ 3 cm 68 (6.7) 24 (4.7) 36 (3.5) 29 (5.7) 697 (68.3) 301 (59.3) 219 (21.5) 154 (30.3) 0.016 < 0.001 CIS - no - yes 105 (6.5) 29 (5.2) 215 (13.3) 62 (11.1) 835 (51.6) 292 (52.1) 462 (28.6) 178 (31.7) 0.865 0.384 Urethra + No Yes 83 (6.2) 2 (4.0) 54 (4.1) 3 (6.0) 840 (63.0) 27 (54.0) 357 (26.8) 18 (36.0) 0.610 0.311 Recurrence No Yes 54 (40.3) 80 (59.7) 115 (41.5) 162 (58.5) 573 (50.8) 554 (49.2) 289 (45.2) 351 (54.8) 0.814 0.022 Progression No Yes 104 (77.6) 30 (22.4) 239 (86.3) 38 (13.7) 898 (79.7) 229 (20.3) 519 (81.1) 121 (18.9) 0.027 0.474 Cancer spec mort No Yes 118 (88.1) 16 (11.9) 258 (93.1) 19 (6.9) 1031 (91.5) 96 (8.5) 577 (90.2) 63 (9.8) 0.084 0.349 OS Alive Dead 91 (67.9) 43 (32.1) 220 (79.4) 57 (20.6) 833 (73.9) 294 (26.1) 496 (77.5) 144 (22.5) 0.011 0.093 Prognostic factors and clinical outcomes of patients undergoing re-TUR according to presence or absence of muscle in the specimen of first TUR. ∗ P1 = Comparison of reTUR in patients without muscle in the specimen ∗∗ P2 = Comparison of reTUR in patients with muscle in the specimen © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e569-e570 Advertisement Copyright & Permissions© 2014MetricsAuthor Information paolo gontero More articles by this author richard Sylvester More articles by this author Francesca Pisano More articles by this author Steven Joniau More articles by this author Kathy Van der Eeckt More articles by this author Vincenzo Serretta More articles by this author Stephane Larrè More articles by this author Savino Di Stasi More articles by this author bas van Rhjin More articles by this author Alfred Witjes More articles by this author anne grotenhuis More articles by this author Bart Kimeney More articles by this author renzo colombo More articles by this author Alberto Briganti More articles by this author Marek Babjuk More articles by this author Viktor soukup More articles by this author Per Uno Malmstrom More articles by this author Jaques Irani More articles by this author Nuria Malats More articles by this author Jack Baniel More articles by this author Roy Mano More articles by this author Tommaso Cai More articles by this author eugene cha More articles by this author Peter Ardelt More articles by this author John varkarakis More articles by this author Riccardo Bartoletti More articles by this author Martin Spahn More articles by this author jouan Palou More articles by this author Guido Dalbagni More articles by this author Evangelous Xylinas More articles by this author Sharok Shariat More articles by this author R. 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