PURPOSE To evaluate the role of a complete transurethral resection of bladder tumors (c-TURBT) on oncological outcomes after radical cystectomy (RC) and its relationship with adverse pathological features. METHODS We retrospectively analyzed data of 727 patients treated with RC and bilateral pelvic lymph node dissection at three tertiary referral centers. Possible c-TURBT was reported by the treating surgeon. Multivariable Cox regression analyses were used to assess the relationship of c-TURBT and survival outcomes after surgery in 1:1 propensity score-matched cohort adjusted for age and gender. Moreover, multivariable logistic regression (MVA) was built to predict the relationship between c-TURBT and pT3-T4 stages at RC, lymph node invasion (LNI) and positive soft tissue surgical margin (STSM). RESULTS A total of 433 (60%) patients received a c-TURBT. 3.0% of patients with a c-TURBT achieved a pT0-pTa-pTis status vs. 2.0% of patients with incomplete TURBT. At multivariable Cox regression analyses, c-TURBT was not associated with survival outcomes. At MVA, incompleteness of TURBT was significantly associated with a pT3-T4 stage [odds ratio (OR) 8.04, 95% confidence interval (CI) 2.33-27.67, p = 0.001]. No significant association was found between c-TURBT, LNI and STSM. CONCLUSION We found a low rate of achievement of pT0 stage at RC. An incomplete TURBT before RC represented a predictor of pT3-T4 stages, but no effect of a c-TURBT was shown on survival outcomes. Given the current inadequacy of clinical staging strategies with more than 50% of extravesical disease being under-staged, our results could improve patients selection for NAC, driving the decision-making in doubtful cases.

中文翻译：

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最后经尿道膀胱肿瘤切除术的完整性对根治性膀胱切除术结局的影响。

目的评估膀胱肿瘤彻底经尿道切除术（c-TURBT）对根治性膀胱切除术（RC）后肿瘤学结果的作用及其与不良病理特征的关系。方法我们回顾性分析了在三个三级转诊中心接受RC和双侧盆腔淋巴结清扫术的727例患者的数据。主治医生报告了可能的c-TURBT。采用多变量Cox回归分析评估了按年龄和性别调整的1：1倾向评分匹配队列中c-TURBT与手术后生存结局的关系。此外，建立了多变量逻辑回归（MVA）来预测RC的c-TURBT和pT3-T4阶段，淋巴结浸润（LNI）和阳性软组织手术切缘（STSM）之间的关系。结果共有433名患者（60％）接受了c-TURBT。3.0％的c-TURBT患者达到了pT0-pTa-pTis状态，而2.0％的不完全TURBT患者达到了pT0-pTa-pTis状态。在多变量Cox回归分析中，c-TURBT与生存结果无关。在MVA，TURBT的不完全性与pT3-T4阶段显着相关[赔率（OR）8.04，95％置信区间（CI）2.33-27.67，p = 0.001]。在c-TURBT，LNI和STSM之间未发现显着关联。结论我们发现RC的pT0分期的完成率很低。RC前不完整的TURBT代表pT3-T4阶段的预测因子，但未显示c-TURBT对生存结果的影响。鉴于目前的临床分期策略不足，超过50％的膀胱外疾病尚处于分阶段，我们的结果可以改善NAC的患者选择，