RISK FACTORS FOR RESIDUAL DISEASE AT RE-TUR IN T1G3 BLADDER CANCER

INTRODUCTION AND OBJECTIVES: Goals of transurethral resection of a bladder tumour (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. It is well known that the presence of detrusor muscle in the specimen is a prerequisite to minimize the risk of under staging. Persistent disease after resection of bladder tumours is not uncommon and is the reason why the European Guidelines recommended a reTUR for all T1 tumours. It was recently published that when there is muscle in the specimen, re-TUR does not influence progression or cancer specific survival. We present here the patient and tumour factors that may influence the presence of residual disease at re-TUR. METHODS: In our retrospective cohort of 2451 primary T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. 75.4% had multifocal tumours, 42.7% of tumours were more than 3 cm in diameter and 25.8% had concomitant CIS. We analyse this subgroup of patients who underwent re-TUR: there was no residual disease in 267 patients (28.6%) and residual disease in 667 patients (71.4%): Ta in 378 (40.5%) and T1 in 289 (30.9%) patients. Age, gender, tumour status (primary/recurrent), previous intravesical therapy, tumour size, tumour multi-focality, presence of concomitant CIS, and muscle in the specimen were analysed in order to evaluate risk factors of residual disease at re-TUR, both in univariate analyses and multivariate logistic regressions. RESULTS: The following were not risk factors for residual disease: age, gender, tumour status and previous intravesical chemotherapy. The following were univariate risk factors for presence of residual disease: no muscle in TUR, multiple tumours, tumours > 3 cm, and presence of concomitant CISDue to the correlation between tumor multi-focality and tumor size, the multivariate model retained either the number of tumors or the tumor diameter (but not both), p < 0.001. The presence of muscle in the specimen was no longer significant, p ¼ 0.15, while the presence of CIS only remained significant in the model with tumor size, p < 0.001. CONCLUSIONS: The most significant factors for a higher risk of residual disease at re-TUR in T1G3 patients are multifocal tumours and tumours more than 3 cm. Patients with concomitant CIS and those without muscle in the specimen also have a higher risk of residual disease

RECURRENCE AND PROGRESSION ACCORDING TO STAGE AT RE-TUR IN T1G3 BLADDER CANCER PATIENTS TREATED WITH BCG: NOT AS BAD AS PREVIOUSLY THOUGHT

INTRODUCTION AND OBJECTIVES The goals of transurethral resection of a bladder tumour (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. Persistent disease after TUR is not uncommon and is the reason why re-TUR is recommended in T1G3 patients. When there is T1 tumour in the re-TUR specimen, very high risks of progression (82%) have been reported1 and therefore cystectomy is considered to be mandatory. We analyse the tumour stage at re-TUR and the risk of recurrence, progression to muscle invasive disease and cancer specific mortality (CSM) in T1G3 patients treated with BCG. METHODS In our retrospective cohort of 2451 T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. There was no residual disease in 267 patients (28.6%) and residual disease in 667 patients (71.4%): Ta in 378 (40.5%) and T1 in 289 (30.9%) patients. 310 patients (33.2%) received more than 6 instillations of BCG. Event rates in the 3 groups were compared using the chi-square statistic on 2 degrees of freedom RESULTS Table 1 shows the observed results with a median follow up of 5.2 years and a maximum follow up of 18.7 years. Similar trends were seen in both patients with and patients without muscle in the original TUR specimen. CONCLUSIONS Patients with T1G3 tumours treated with BCG and no residual disease or Ta tumour at re-TUR have better recurrence, progression and CSM rates than those with T1 tumour. The 25.3% progression rate of patients with T1 disease after re-TUR is far lower than that previously reported, with a CSM rate of 13.1%

THE IMPACT OF DIFFERENT BCG STRAINS ON OUTCOME IN A LARGE COHORT OF T1G3 PATIENTS TREATED WITH BCG

There are few RCT\u2019s comparing different BCG strains. As a consequence, there is limited information available on the difference in their efficacy in the treatment of patients with NMIBC. A trial from 1995 showed that an induction course BCG RIVM significantly reduced the number of recurrences compared to an induction course of BCG Tice [Vegt et al, J Urol 1995]. A recently published trial [Rentsch et al, Eur Urol 2014] also found an induction course of BCG Connaught to be significantly better in the reduction of recurrences than an induction course of BCG Tice. We retrospectively compared the outcomes after BCG Connaught and BCG Tice in a large study cohort of high risk NMIBC patients, and looked at recurrence, progression and cancer specific survival (CSS)