1704 THE EFFECT OF REPEAT TRANSURETHRAL RESECTION ON RECURRENCE RATES IN PATIENTS WITH NON MUSCLE INVASIVE BLADDER CANCER WHO RECEIVED INTRAVESICAL BACILLUS CALMETTE-GUERIN

Abstract

You have accessJournal of UrologyBladder Cancer: Superficial (I)1 Apr 20131704 THE EFFECT OF REPEAT TRANSURETHRAL RESECTION ON RECURRENCE RATES IN PATIENTS WITH NON MUSCLE INVASIVE BLADDER CANCER WHO RECEIVED INTRAVESICAL BACILLUS CALMETTE-GUERIN John P. Sfakianos, Philip H. Kim, and Harry W. Herr John P. SfakianosJohn P. Sfakianos New York, NY More articles by this author , Philip H. KimPhilip H. Kim New York, NY More articles by this author , and Harry W. HerrHarry W. Herr New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3014AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The standard of care for non muscle invasive bladder cancer (NMIBC) is transurethral resection (TUR) with or without adjuvant intravesical therapy. A repeat TUR has been associated with a decreased risk of recurrence and progression, likely due to improved staging and therapeutic intervention. We sought to identify if repeat resection prior to initiation of intravesical BCG improved recurrence free rates. METHODS We retrospectively analyzed 1021 patients with NMIBC treated with intravesical BCG at our institution. All patients underwent a second resection, except for those who were already undergoing BCG treatment at consultation or refused a repeat resection. Repeat resections were performed within 2-6 weeks after the initial procedure (patients upstaged to pT2 were excluded). All patients were followed every 3 to 6 months for a minimum of 5 years. Recurrence was assessed at 3, 6 and 12 months with office cystoscopy, cytology and resection of bladder tumors when indicated. RESULTS Of 1021 patients who underwent initial TUR of their tumor, 127 (12.5%) had only a single TUR while 894 (87.5%) had a repeat TUR before intravesical BCG instillation. The median age of our cohort was 63, with 756 (74%) males. At initial presentation we identified 612 (59.9%) and 409 (40.1%) pTa and pT1 tumors, respectively. 769 (75.3%) were high-grade tumors and CIS was found in 629 (61.6%). At repeat TUR, 421 (41.2%) were found to be free of tumor, while 109 (10.7%), 211 (20.7%), 138 (13.5%), and 142 (13.9%) and were found to have papilloma, pTis only, pTa, and pT1 respectively. On univariate analysis, tumor grade, presence of CIS on initial TUR, tumor present on repeat TUR and having a single TUR were predictors of recurrence at 3 and 6 months (all p <0.003). Grade, presence of tumor on repeat TUR and a single TUR were also predictors of recurrence at 12 months (all p <0.001). On multivariate analysis presence of tumor on repeat TUR (OR 5.6 95% CI 3.0, 10.2; p <0.001) and a single TUR (OR 4.4% CI 2.8, 6.9; p <0.001) were predictors of recurrence at 3 months. On Kaplan-Meier analysis, time to recurrence for a single TUR was significantly decreased compared to those receiving a repeat TUR (median 22 months versus 36 months, p <0.001). CONCLUSIONS Repeat resection prior to initiation of intravesical BCG therapy decreased recurrence rates at 3, 6 and 12 months. We believe repeat resection should therefore be performed prior to initiating BCG therapy for superficial bladder cancer. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e701 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information John P. Sfakianos New York, NY More articles by this author Philip H. Kim New York, NY More articles by this author Harry W. Herr New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...