Long-term Outcomes from Re-resection for High-risk Non-muscle-invasive Bladder Cancer: A Potential to Rationalize Use

Abstract

Background: Guidelines advocate early re-resection for these cancers, although the benefits are unclear and the uniform need is questioned. Here, we compare the outcomes using a large single-center cohort.

Objectives: To compare the outcomes of patients with high-grade non-muscle-invasive bladder cancer (BC) who underwent and who did not undergo re-resection following their initial treatment.

Design, setting, and participants: We identified all eligible patients with a new diagnosis treated between 1994 and 2009 in Sheffield. We annotated these with hospital and registry records.

Outcome measurements and statistical analysis: Primary outcomes were disease-specific and overall survival. Secondary outcomes were the findings at re-resection, rates of muscle invasion, and radical treatment. Statistical tests were two tailed and significance defined as p<0.05.

Results and limitations: We identified 932 eligible patients, including 229(25%) who underwent re-resection within 12 wk and 234 (25%) within 3-6 mo after diagnosis. Clinicopathological criteria were similar in patients with and without re-resection. Histological findings on re-resection were no residual cancer in 91 (20%) and BC in 138 (30%: 15 low-grade and 85 high-grade non-muscle-invasive cancers, and 38 muscle-invasive cancers). Patients with re-resection were more frequently diagnosed with muscle invasion (126 [27%] vs 49 [11%], chi-square p<0.001) and more commonly underwent radical treatment (127 [27%] vs 35 [8%], p<0.001) than those without re-resection. A total of 207 patients died from BC, including 46 (22%) with and 161 (78%) without re-resection. Patients who underwent re-resection within 3 mo had significantly higher disease-specific (log rank p=0.009) and overall survival (p<0.001) survival compared with those who did not. Differences were present only for patients with pT1 cancer at diagnosis.

Conclusions: Patients undergoing re-resection within 3 mo of diagnosis were more likely to have histologically identified muscle invasion, were more likely to undergo radical treatment, and had a higher survival rate. The differences were greatest in patients with lamina propria invasion, suggesting the potential to avoid in others. Limitations of our work include retrospective design and selection bias.

Patient summary: Patients undergoing re-resection after a diagnosis of high-grade non-muscle-invasive bladder cancer had higher disease-specific and overall survival rates due to more accurate diagnosis and appropriate subsequent radical treatment. Re-resection carries greatest benefit to patients with lamina propria invasion at diagnosis.

Keywords: Bladder cancer; High-grade non-muscle invasive; Re-resection; Urothelial cancer.