Repeat transurethral resection and contemporary oncologic outcomes among patients with non-muscle invasive urothelial carcinoma of the bladder

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Abstract
Purpose Repeat transurethral resection (re-TURBT) is recommended for all patients with high-risk bladder cancer to improve staging and oncologic outcomes. However, contemporary evidence on the role of re-TURBT is lacking. We therefore examined the contemporary rates of upstaging at re-TURBT and the association of re-TURBT with disease recurrence and progression. Materials and methods We identified patients with an incident diagnosis of high-grade Ta, low-grade T1 and high-grade T1 urothelial carcinoma of the bladder between 2010 and 2022. The association of re-TURBT with disease recurrence and progression was evaluated using Cox regression. Rates and predictors of residual tumor and upstaging at re-TURBT were evaluated using univariable logistic regression. Results A total of 328 patients were included, of whom 88 (27%) underwent re-TURBT. Among those who underwent re-TURBT, 9 (10%) were upstaged to ≥ T2, while 39 (44%) were found to have residual non-muscle invasive disease. Median follow-up time was 13 and 24 months for RFS and PFS, respectively. In a multivariable analysis, re-TURBT was not associated with a significant difference in disease recurrence or progression compared with no re-TURBT. In unadjusted analysis, a higher Charlson index was associated with an increased risk of upstaging and residual tumors. A greater number of tumors was associated with increased risks of residual tumor at re-TURBT. Conclusions In a contemporary cohort of patients with bladder cancer, the rate of upstaging at re-TURBT was 10%, lower than historical studies. The rate of residual non-muscle invasive disease remains high at 44%. Re-TURBT was not associated with a statistically significant difference in disease recurrence or progression.

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