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
