Impact of Maximal Transurethral Resection on Pathological Outcomes at Cystectomy in a Large, Multi-institutional Cohort

No AccessJournal of UrologyAdult Urology1 May 2023Impact of Maximal Transurethral Resection on Pathological Outcomes at Cystectomy in a Large, Multi-institutional CohortThis article is commented on by the following:Editorial Comment 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, and Jonathan L. Wright Peter S. KirkPeter S. Kirk *Correspondence: Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 telephone: 206-598-4294; E-mail Address: [email protected] Department of Urology, University of Washington, Seattle, Washington More articles by this author , Yair LotanYair Lotan Department of Urology, University of Texas Southwestern, Dallas, Texas More articles by this author , Homayoun ZargarHomayoun Zargar Department of Urology, Western Health, Melbourne, Australia More articles by this author , Adrian S. FaireyAdrian S. Fairey USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, California University of Alberta, Edmonton, Alberta, Canada More articles by this author , Colin P. DinneyColin P. Dinney Department of Urology, MD Anderson Cancer Center, Houston, Texas More articles by this author , Maria C. MirMaria C. Mir Department of Urology, Fundacio Instituto Valenciano de Oncologia, Valencia, Spain More articles by this author , Laura-Maria KrabbeLaura-Maria Krabbe Department of Urology, University of Münster, Münster, Germany More articles by this author , Michael S. CooksonMichael S. Cookson Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma More articles by this author , Niels-Erik JacobsonNiels-Erik Jacobson University of Alberta, Edmonton, Alberta, Canada More articles by this author , Jeffrey S. MontgomeryJeffrey S. Montgomery Department of Urology, University of Michigan Health System, Ann Arbor, Michigan More articles by this author , Nikhil VasdevNikhil Vasdev Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, United Kingdom Department of Urology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom More articles by this author , Evan Y. YuEvan Y. Yu Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington Fred Hutchinson Cancer Center, Seattle, Washington More articles by this author , Evanguelos XylinasEvanguelos Xylinas Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, New York More articles by this author , Wassim KassoufWassim Kassouf Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada More articles by this author , Marc A. Dall’EraMarc A. Dall’Era Department of Urology, University of California at Davis, Davis Medical Center, Sacramento, California More articles by this author , Srikala S. SridharSrikala S. Sridhar Princess Margaret Hospital, Toronto, Ontario, Canada More articles by this author , Jonathan S. McGrathJonathan S. McGrath Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, United Kingdom More articles by this author , Jonathan AningJonathan Aning Department of Urology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, United Kingdom More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat Department of Urology, University of Texas Southwestern, Dallas, Texas Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, New York Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria More articles by this author , Andrew C. ThorpeAndrew C. Thorpe Department of Urology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom More articles by this author , Todd M. MorganTodd M. Morgan Department of Urology, University of Michigan Health System, Ann Arbor, Michigan More articles by this author , Jeff M. HolzbeierleinJeff M. Holzbeierlein Department of Urology, University of Kansas Medical Center, Kansas City, Kansas More articles by this author , Trinity J. BivalacquaTrinity J. Bivalacqua Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author , Scott NorthScott North Division of Urology, Cross Cancer Institute, Edmonton, Alberta, Canada More articles by this author , Daniel A. BarocasDaniel A. Barocas Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author , Petros GrivasPetros Grivas Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington Fred Hutchinson Cancer Center, Seattle, Washington More articles by this author , Jorge A. GarciaJorge A. Garcia Case Comprehensive Cancer Center, Cleveland, Ohio More articles by this author , Andrew J. StephensonAndrew J. Stephenson Department of Urology, Rush University, Chicago, Illinois More articles by this author , Jay B. ShahJay B. Shah Department of Urology, Stanford University, Palo Alto, California More articles by this author , Siamak DaneshmandSiamak Daneshmand USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, California More articles by this author , Philippe E. SpiessPhilippe E. Spiess Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida More articles by this author , Bas W. G. van RhijnBas W. G. van Rhijn Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany More articles by this author , Laura MertensLaura Mertens Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands More articles by this author , Peter BlackPeter Black Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada More articles by this author , and Jonathan L. WrightJonathan L. Wright Department of Urology, University of Washington, Seattle, Washington Fred Hutchinson Cancer Center, Seattle, Washington More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003193AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: 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. Materials and Methods: 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. Results: 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). Conclusions: 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. REFERENCES 1. . A systematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer. Urol Oncol. 2018; 36(2):43-53. Crossref, Medline, Google Scholar 2. Advanced Bladder Cancer Overview Collaboration. Neoadjuvant chemotherapy for invasive bladder cancer. Cochrane Database Syst Rev. 2005; 2004(2):CD005246. Medline, Google Scholar 3. . Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. 2003; 349(9):859-866. Crossref, Medline, Google Scholar 4. . 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Conflict of Interest: P.G.: Consultant: AstraZeneca, Astellas Pharma, Boston Gene, Bristol Myers Squibb, Dyania Health, EMD Serono, Exelixis, Fresenius Kabi, G1 Therapeutics, Genentech/Roche, Gilead Sciences, GlaxoSmithKline, Guardant Health, Infinity Pharmaceuticals, Janssen, Lucence Health, Merck & Co., Mirati Therapeutics, Pfizer, PureTech, QED Therapeutics, Regeneron Pharmaceuticals, Seattle Genetics, Silverback Therapeutics, 4D Pharma PLC, UroGen; M.S.C.: Remedica Medical Education & Publishing, Lantheus, Janssen Pharmaceuticals, Pacific Edge Diagnostics USA Ltd, Janssen Biotech LLC, Natera, Pfizer, Bayer, MJH LifeSciences, Nonagen Bioscience Corp, Clinical Education Alliance LLC, Prokarium Ltd, Billing Cochran Lyles, MDXHealth, Walters Stanley & Natarajan LLP, Propella, Rhodes & Hieryonymus, BioPharm Communications, Myovant Sciences Inc, Williams Hall Latherow, Merck & Company Inc, Janssen Scientific Affairs LLC, TesoRx Pharma LLC, Segal McCambridge, Moscarino & Treu LLP, Fallon Medica (Bayer), Ferring Pharmaceuticals Inc, Bayer Pharma AG, Bayer Healthcare Pharmaceuticals Inc, Sturgill Turner Barker & Maloney PLLC, Bayer HealthCare AG, Astellas Pharma US Inc, Boehl Stopher & Graves LLP; C.P.D.: AZ; Y.L.: Consultant: Nanorobotics, C2I genomics, Photocure, Astra-Zeneca, Merck, Fergene, Abbvie, Cleveland Diagnostics, Nucleix, Ambu, Seattle Genetics, Hitachi, Ferring Research, Verity Pharmaceuticals, Virtuoso Surgical, Stimit, Urogen, Vessi, CAPs Medical, Xcures, BMS, Nonagen, Aura Biosciences, Convergent Genomics; E.Y.V.: Consultant: Abbvie, Advanced Accelerator Applications, Bayer, Clovis, Exelixis, Genzyme, Janssen, Merck, Oncternal; W.K.: Merck, EMD Serono, Sesen Bio, Bayer, BMS, Janssen, Ferring; J.L.W.: Janssen, Merck. Ethics Statement: Institutional Review Board approval was obtained from each participating institution. Editor's Note: This article is the first of 5 published in this issue for which Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1033 and 1034. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySiemens D (2023) This Month in Adult UrologyJournal of Urology, VOL. 209, NO. 5, (821-822), Online publication date: 1-May-2023.Croll B and Joshi S (2023) Editorial CommentJournal of Urology, VOL. 209, NO. 5, (888-889), Online publication date: 1-May-2023.Related articlesJournal of Urology16 Feb 2023Editorial Comment Volume 209Issue 5May 2023Page: 882-889 Peer Review Report Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Keywordscystectomymargins of excisionneoplasm stagingurinary bladder neoplasmsMetricsAuthor Information Peter S. Kirk Department of Urology, University of Washington, Seattle, Washington *Correspondence: Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 telephone: 206-598-4294; E-mail Address: [email protected] More articles by this author Yair Lotan Department of Urology, University of Texas Southwestern, Dallas, Texas More articles by this author Homayoun Zargar Department of Urology, Western Health, Melbourne, Australia More articles by this author Adrian S. Fairey USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, California University of Alberta, Edmonton, Alberta, Canada More articles by this author Colin P. Dinney Department of Urology, MD Anderson Cancer Center, Houston, Texas More articles by this author Maria C. Mir Department of Urology, Fundacio Instituto Valenciano de Oncologia, Valencia, Spain More articles by this author Laura-Maria Krabbe Department of Urology, University of Münster, Münster, Germany More articles by this author Michael S. Cookson Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma More articles by this author Niels-Erik Jacobson University of Alberta, Edmonton, Alberta, Canada More articles by this author Jeffrey S. Montgomery Department of Urology, University of Michigan Health System, Ann Arbor, Michigan More articles by this author Nikhil Vasdev Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, United Kingdom Department of Urology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom More articles by this author Evan Y. Yu Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington Fred Hutchinson Cancer Center, Seattle, Washington More articles by this author Evanguelos Xylinas Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, New York More articles by this author Wassim Kassouf Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada More articles by this author Marc A. Dall’Era Department of Urology, University of California at Davis, Davis Medical Center, Sacramento, California More articles by this author Srikala S. Sridhar Princess Margaret Hospital, Toronto, Ontario, Canada More articles by this author Jonathan S. McGrath Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, United Kingdom More articles by this author Jonathan Aning Department of Urology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, United Kingdom More articles by this author Shahrokh F. Shariat Department of Urology, University of Texas Southwestern, Dallas, Texas Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, New York Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria More articles by this author Andrew C. Thorpe Department of Urology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom More articles by this author Todd M. Morgan Department of Urology, University of Michigan Health System, Ann Arbor, Michigan More articles by this author Jeff M. Holzbeierlein Department of Urology, University of Kansas Medical Center, Kansas City, Kansas More articles by this author Trinity J. Bivalacqua Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author Scott North Division of Urology, Cross Cancer Institute, Edmonton, Alberta, Canada More articles by this author Daniel A. Barocas Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author Petros Grivas Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington Fred Hutchinson Cancer Center, Seattle, Washington More articles by this author Jorge A. Garcia Case Comprehensive Cancer Center, Cleveland, Ohio More articles by this author Andrew J. Stephenson Department of Urology, Rush University, Chicago, Illinois More articles by this author Jay B. Shah Department of Urology, Stanford University, Palo Alto, California More articles by this author Siamak Daneshmand USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, California More articles by this author Philippe E. Spiess Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida More articles by this author Bas W. G. van Rhijn Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany More articles by this author Laura Mertens Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands More articles by this author Peter Black Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada More articles by this author Jonathan L. Wright Department of Urology, University of Washington, Seattle, Washington Fred Hutchinson Cancer Center, Seattle, Washington More articles by this author Expand All Support: This study was supported by the Seattle Translational Tumor Research Program at Fred Hutchinson Cancer Center (E.Y.Y., P.G., J.L.W.). Conflict of Interest: P.G.: Consultant: AstraZeneca, Astellas Pharma, Boston Gene, Bristol Myers Squibb, Dyania Health, EMD Serono, Exelixis, Fresenius Kabi, G1 Therapeutics, Genentech/Roche, Gilead Sciences, GlaxoSmithKline, Guardant Health, Infinity Pharmaceuticals, Janssen, Lucence Health, Merck & Co., Mirati Therapeutics, Pfizer, PureTech, QED Therapeutics, Regeneron Pharmaceuticals, Seattle Genetics, Silverback Therapeutics, 4D Pharma PLC, UroGen; M.S.C.: Remedica Medical Education & Publishing, Lantheus, Janssen Pharmaceuticals, Pacific Edge Diagnostics USA Ltd, Janssen Biotech LLC, Natera, Pfizer, Bayer, MJH LifeSciences, Nonagen Bioscience Corp, Clinical Education Alliance LLC, Prokarium Ltd, Billing Cochran Lyles, MDXHealth, Walters Stanley & Natarajan LLP, Propella, Rhodes & Hieryonymus, BioPharm Communications, Myovant Sciences Inc, Williams Hall Latherow, Merck & Company Inc, Janssen Scientific Affairs LLC, TesoRx Pharma LLC, Segal McCambridge, Moscarino & Treu LLP, Fallon Medica (Bayer), Ferring Pharmaceuticals Inc, Bayer Pharma AG, Bayer Healthcare Pharmaceuticals Inc, Sturgill Turner Barker & Maloney PLLC, Bayer HealthCare AG, Astellas Pharma US Inc, Boehl Stopher & Graves LLP; C.P.D.: AZ; Y.L.: Consultant: Nanorobotics, C2I genomics, Photocure, Astra-Zeneca, Merck, Fergene, Abbvie, Cleveland Diagnostics, Nucleix, Ambu, Seattle Genetics, Hitachi, Ferring Research, Verity Pharmaceuticals, Virtuoso Surgical, Stimit, Urogen, Vessi, CAPs Medical, Xcures, BMS, Nonagen, Aura Biosciences, Convergent Genomics; E.Y.V.: Consultant: Abbvie, Advanced Accelerator Applications, Bayer, Clovis, Exelixis, Genzyme, Janssen, Merck, Oncternal; W.K.: Merck, EMD Serono, Sesen Bio, Bayer, BMS, Janssen, Ferring; J.L.W.: Janssen, Merck. Ethics Statement: Institutional Review Board approval was obtained from each participating institution. Editor's Note: This article is the first of 5 published in this issue for which Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1033 and 1034. Advertisement PDF downloadLoading ...