THE IMPACT OF RE-TUR ON CLINICAL OUTCOMES IN A LARGE COHORT OF T1G3 PATIENTS TREATED WITH BCG.

Scopo del lavoro 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. Materiali e metodi 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. Risultati 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. Discussione Even if re TUR is recommended in high risk tumors, it can delay the intravescial therapy. When muscle is present in TUR specimen the risk of substaging or residual tumor should be balanced with the need of keep on with adequate treatments. Conclusioni 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.