The use of reTURB in T1 bladder cancer: a Norwegian population-based study

Abstract

Aim

To evaluate the use of repeat transurethral resection of the bladder (reTURB) in stage T1 bladder cancer and its impact on treatment and survival in a Norwegian population-based cohort.

Material and methods

1130 patients registered at the Cancer Registry of Norway between 2008 and 2012 with primary urothelial T1 cancer were included. Information on surgical and medical procedures was provided by the Norwegian Patient Registry. Descriptive statistics were used to evaluate characteristics of patients receiving reTURB or not within 12 weeks from primary TURB (primTURB). Survival models identified risk factors and estimated cause-specific survival rates (CSS) adjusted for sex, age, WHO grade, concomitant cis and detrusor muscle at primTURB and treatment.

Results

The 648 (57%) T1 patients with reTURB were significantly younger and had more WHO high grade tumors compared to those without reTURB. Of 275 patients without detrusor muscle at primTURB 114 (41%) had no reTURB. Of reTURB patients, 45 (7%) had muscle invasive tumor, 110 (17%) T1 and 378 (58%) Ta, cis or T0. Two-thirds of 81 patients receiving early cystectomy after reTURB had T1 or muscle invasive bladder cancer at reTURB. ReTURB did not impact adjusted CSS, but patients with T1 at reTURB had significantly lower CSS than those with < T1 conditions.

Conclusions

Almost half of the T1 patients did not undergo reTURB as recommended in guidelines. We show that reTURB makes the histology result more reliable with impact on both treatment and survival. Our results support the use of reTURB as recommended by EAU guidelines.

Keywords:

• Urothelial carcinoma
• urinary bladder cancer
• T1
• TURB
• repeated TURB
• survival

Author contributions

BKA conceived, coordinated, and designed the study, performed the statistical analysis, and drafted the manuscript together with AB and SF. RB contributed to the data management. AB was responsible for the clinical assessment of the patients included and, together with SF, contributed in the interpretation of the results, background knowledge on bladder cancer and writing the manuscript. All authors participated in writing of the manuscript and revised it critically. All authors have read and approved the final version of the manuscript.

Disclosure statement

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

Additional information

Funding

This work is funded by Samarbeidsorganet, The University Hospital of Trondheim, St Olavs Hospital, Norway.