While the presence of residual disease at the time of radical cystectomy for bladder cancer is an established prognostic indicator, controversy remains regarding the importance of maximal transurethral resection prior to neoadjuvant chemotherapy. We characterized the influence of maximal transurethral resection on pathological and survival outcomes using a large, multi-institutional cohort.
We identified 785 patients from a multi-institutional cohort undergoing radical cystectomy for muscle-invasive bladder cancer after neoadjuvant chemotherapy. We employed bivariate comparisons and stratified multivariable models to quantify the effect of maximal transurethral resection on pathological findings at cystectomy and survival.
Of 785 patients, 579 (74%) underwent maximal transurethral resection. Incomplete transurethral resection was more frequent in patients with more advanced clinical tumor (cT) and nodal (cN) stage (P < .001 and P < .01, respectively), with more advanced ypT stage at cystectomy and higher rates of positive surgical margins (P < .01 and P < .05, respectively). In multivariable models, maximal transurethral resection was associated with downstaging at cystectomy (adjusted odds ratio 1.6, 95% CI 1.1-2.5). In Cox proportional hazards analysis, maximal transurethral resection was not associated with overall survival (adjusted HR 0.8, 95% CI 0.6-1.1).
In patients undergoing transurethral resection for muscle-invasive bladder cancer prior to neoadjuvant chemotherapy, maximal resection may improve pathological response at cystectomy. However, the ultimate effects on long-term survival and oncologic outcomes warrant further investigation.
The Journal of urology. 2023 Feb 16 [Epub ahead of print]
Peter S Kirk, Yair Lotan, Homayoun Zargar, Adrian S Fairey, Colin P Dinney, Maria C Mir, Laura-Maria Krabbe, Michael S Cookson, Niels-Erik Jacobson, Jeffrey S Montgomery, Nikhil Vasdev, Evan Y Yu, Evanguelos Xylinas, Wassim Kassouf, Marc A Dall'Era, Srikala S Sridhar, Jonathan S McGrath, Jonathan Aning, Shahrokh F Shariat, Andrew C Thorpe, Todd M Morgan, Jeff M Holzbeierlein, Trinity J Bivalacqua, Scott North, Daniel A Barocas, Petros Grivas, Jorge A Garcia, Andrew J Stephenson, Jay B Shah, Siamak Daneshmand, Philippe E Spiess, Bas W G van Rhijn, Laura Mertens, Peter Black, Jonathan L Wright
Department of Urology, University of Washington, Seattle, Washington., Department of Urology, University of Texas Southwestern, Dallas, Texas., Department of Urology, Western Health, Melbourne, Australia., USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, California., Department of Urology, MD Anderson Cancer Center, Houston, Texas., Department of Urology, Fundacio Instituto Valenciano de Oncologia, Valencia, Spain., Department of Urology, University of Münster, Münster, Germany., Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma., University of Alberta, Edmonton, Alberta, Canada., Department of Urology, University of Michigan Health System, Ann Arbor, Michigan., Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, United Kingdom., Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington., Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, New York., Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada., Department of Urology, University of California at Davis, Davis Medical Center, Sacramento, California., Princess Margaret Hospital, Toronto, Ontario, Canada., Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, United Kingdom., Department of Urology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom., Department of Urology, University of Kansas Medical Center, Kansas City, Kansas., Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania., Division of Urology, Cross Cancer Institute, Edmonton, Alberta, Canada., Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Case Comprehensive Cancer Center, Cleveland, Ohio., Department of Urology, Rush University, Chicago, Illinois., Department of Urology, Stanford University, Palo Alto, California., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida., Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.