A population-based study on the effect of a routine second-look resection on survival in primary stage T1 bladder cancer

Abstract

Objective

To assess the value of second-look resection (SLR) in stage T1 bladder cancer (BCa) with respect to progression-free survival (PFS), and also the secondary outcomes recurrence-free survival (RFS), bladder-cancer-specific survival (CSS), and cystectomy-free survival (CFS).

Patients and methods

The study included 2456 patients diagnosed with stage T1 BCa 2004–2009 with 5-yr follow-up registration in the nationwide Bladder Cancer Data Base Sweden (BladderBaSe). PFS, RFS, CSS, and CFS were evaluated in stage T1 BCa patients with or without routine SLR, using univariate and multivariable Cox regression with adjustment for multiple confounders (age, gender, tumour grade, intravesical treatment, hospital volume, comorbidity, and educational level).

Results

SLR was performed in 642 (26%) individuals, and more frequently on patients who were aged < 75 yr, had grade 3 tumours, and had less comorbidity. There was no association between SLR and PFS (hazard ratio [HR] 1.1, confidence interval [CI] 0.85–1.3), RFS (HR 1.0, CI 0.90–1.2), CFS (HR 1.2, CI 0.95–1.5) or CSS (HR 1.1, CI 0.89–1.4).

Conclusions

We found similar survival outcomes in patients with and patients without SLR, but our study is likely affected by selection mechanisms. A randomised study defining the role of SLR in stage T1 BCa would be highly relevant to guide current praxis.

Keywords:

• Bladder cancer
• transurethral resection
• second look resection
• T1

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Swedish Cancer Society [grant numbers CAN 2019/62 and CAN 2017/278], Lund Medical Faculty (ALF), Skåne University Hospital Research Funds, the Gyllenstierna Krapperup’s Foundation, The Cancer Research Fund at Malmö General Hospital, Stiftelsen Sigurd och Elsa Goljes Minne, The Bergqvist Foundation, Skåne County Council’s Research and Development Foundation [REGSKANE-622351], Gösta Jönsson Research Foundation, the Foundation of Urological Research (Ove and Carin Carlsson bladder cancer donation), and Hillevi Fries Research Foundation. The funding sources had no role in the study design, data analyses, interpretation of the results, or writing the manuscript.