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The prognostic value of routine second transurethral resection in patients with newly diagnosed stage pT1 non-muscle-invasive bladder cancer: results from randomized 10-year extension trial

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Abstract

Purpose

To evaluate the impact of routine second TUR on the long-term outcome of patients with newly diagnosed stage pT1 non-muscle-invasive bladder cancer (NMIBC)

Material and methods

A total of 210 patients (mean age 62.1 years, 89.5% were males) with stage pT1 NMIBC who underwent first TUR were prospectively randomized into two groups including second TUR (n = 105) and no second TUR (n = 105) groups. Data on recurrence, disease progression, 7-year and 10-year recurrence-free survival (RFS), progression-free survival (PFS) and overall survival (OS) were recorded.

Results

The median follow-up time was 119 months (IQR 65-168). Per-protocol (PP) analysis revealed that compared to patients without second TUR, patients with second TUR had significantly higher 5-year, 7-year and 10-year rates for RFS (59.4%, 57.9% and 54.8% vs. 36.3%, 31.7% and 26.8%, respectively, p < 0.001) and PFS (93.3%, 91.9% and 90.4% vs. 74.0%, 71.4% and 68.5%, respectively, p < 0.001). According to PP and intention-to-treat (ITT) analyses, the 10-year OS rate was significantly higher in patients with second TUR (59.1 vs. 40.8%, p = 0.004). Multivariate analysis revealed that undergoing second TUR (OR 1.661, 95% CI 1.156–2.385, p = 0.006) was an independent determinant of prolonged OS.

Conclusions

In conclusion, these findings indicate the prognostic value of second TUR in stage pT1 NMIBC patients, not only for RFS and PFS advantages but also for the long-term OS advantage. Therefore, second TUR should be routinely performed in all stage pT1 NMIBC patients with life expectancy of at least 10 years, given the positive contribution to all oncological outcomes.

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Abbreviations

CIS:

Carcinoma in situ

ITP:

Intention-to-treat

MMC:

Mitomycin

NMIBC:

Non-muscle-invasive bladder cancer

OS:

Overall survival

PFS:

Progression-free survival

PP:

Per protocol

RFS:

Recurrence-free survival

TUR:

Transurethral resection

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Authors and Affiliations

  1. Baskent University Zubeyde Hanim Hospital, Izmir, Turkey

    Askin Eroglu

  2. Urla State Hospital, Izmir, Turkey

    Rahmi Gokhan Ekin

  3. Tepecik Training and Research Hospital, Izmir, Turkey

    Gokhan Koc

  4. Ege Sehir Hospital, Izmir, Turkey

    Rauf Taner Divrik

Authors
  1. Askin Eroglu
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  2. Rahmi Gokhan Ekin
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  3. Gokhan Koc
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  4. Rauf Taner Divrik
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Correspondence to Askin Eroglu.

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Eroglu, A., Ekin, R.G., Koc, G. et al. The prognostic value of routine second transurethral resection in patients with newly diagnosed stage pT1 non-muscle-invasive bladder cancer: results from randomized 10-year extension trial. Int J Clin Oncol 25, 698–704 (2020). https://doi.org/10.1007/s10147-019-01581-0

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  • DOI: https://doi.org/10.1007/s10147-019-01581-0

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