The Effect of Restaging Transurethral Resection on Recurrence and Progression Rates in Patients with Nonmuscle Invasive Bladder Cancer Treated with Intravesical Bacillus Calmette-Guérin

No AccessJournal of UrologyAdult Urology1 Feb 2014The Effect of Restaging Transurethral Resection on Recurrence and Progression Rates in Patients with Nonmuscle Invasive Bladder Cancer Treated with Intravesical Bacillus Calmette-Guérin John P. Sfakianos, Philip H. Kim, A. Ari Hakimi, and Harry W. Herr John P. SfakianosJohn P. Sfakianos More articles by this author , Philip H. KimPhilip H. Kim More articles by this author , A. Ari HakimiA. Ari Hakimi More articles by this author , and Harry W. HerrHarry W. Herr More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.08.022AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determined whether restaging resection before initiating induction intravesical bacillus Calmette-Guérin improves the recurrence-free rate in patients with high risk nonmuscle invasive bladder cancer. Materials and Methods: We retrospectively analyzed data on 1,021 patients treated at our institution with intravesical bacillus Calmette-Guérin for nonmuscle invasive high risk bladder cancer. All patients underwent a second resection except those already receiving bacillus Calmette-Guérin at the time of initial consultation and those who refused restaging resection. All patients were assessed every 3 to 12 months for a minimum of 5 years. Univariate and multivariate regression was used to identify predictors of 5-year recurrence. Results: Restaging transurethral resection was performed in 894 patients (87.5%). At restaging resection viable tumor was found in 496 patients (55.5%). At 3 months patients with a single resection had a 44.3% recurrence rate compared to 9.6% in those with restaging resection (p <0.01). On multivariate analysis a single transurethral resection was the only predictor of recurrence at 5 years (OR 2.1, 95% CI 1.3–3.3, p = 0.01). Time to recurrence in patients with a single resection was significantly shorter than in those with restaging resection (median 22 vs 36 months, p <0.001). Conclusions: Failure to repeat resection before initiating intravesical bacillus Calmette-Guérin therapy for high risk nonmuscle invasive bladder cancer significantly increases the risk of recurrence. Therefore, we believe that restaging resection should be performed before initiating bacillus Calmette-Guérin therapy in all patients with high risk nonmuscle invasive bladder cancer. References 1 : Bacillus Calmette-Guerin immunotherapy of superficial bladder cancer. J Urol1980; 124: 38. Link, Google Scholar 2 : Effect of intravesical Bacillus Calmette-Guerin (BCG) on carcinoma in situ of the bladder. Cancer1983; 51: 1323. Google Scholar 3 : A randomized trial of intravesical doxorubicin and immunotherapy with bacille Calmette-Guerin for transitional-cell carcinoma of the bladder. N Engl J Med1991; 325: 1205. 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Link, Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHussein A and Guru K (2017) Editorial CommentaryUrology Practice, VOL. 5, NO. 2, (138-138), Online publication date: 1-Mar-2018.Anderson C, Weber R, Patel D, Lowrance W, Mellis A, Cookson M, Lang M, Barocas D, Chang S, Newberger E, Montgomery J, Weizer A, Lee C, Kava B, Jackson M, Meraney A, Sjoberg D, Bochner B, Dalbagni G, Donat M and Herr H (2016) A 10-Item Checklist Improves Reporting of Critical Procedural Elements during Transurethral Resection of Bladder TumorJournal of Urology, VOL. 196, NO. 4, (1014-1020), Online publication date: 1-Oct-2016.Ozgur B and Yuceturk C (2016) Re: Renin-Angiotensin Inhibitors Decrease Recurrence after Transurethral Resection of Bladder Tumor in Patients with Nonmuscle Invasive Bladder CancerJournal of Urology, VOL. 196, NO. 3, (960-961), Online publication date: 1-Sep-2016.Blute M, Rushmer T, Shi F, Fuller B, Abel E, Jarrard D and Downs T (2015) Renin-Angiotensin Inhibitors Decrease Recurrence after Transurethral Resection of Bladder Tumor in Patients with Nonmuscle Invasive Bladder CancerJournal of Urology, VOL. 194, NO. 5, (1214-1219), Online publication date: 1-Nov-2015.Mostafid H, Kirby R, Fitzpatrick J and Bryan R (2014) The Safe and Economical Care of Ta Bladder CancerUrology Practice, VOL. 1, NO. 4, (176-183), Online publication date: 1-Nov-2014. Volume 191Issue 2February 2014Page: 341-345 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.KeywordscarcinomareoperationBCG vaccineurinary bladderneoplasm recurrencelocalMetricsAuthor Information John P. Sfakianos More articles by this author Philip H. Kim More articles by this author A. Ari Hakimi More articles by this author Harry W. Herr More articles by this author Expand All Advertisement PDF downloadLoading ...