title: Use of restaging bladder tumor resection for bladder cancer among Medicare beneficiaries.
abstract: OBJECTIVE
  To evaluate the use and effectiveness of restaging bladder tumor resection using population-based data. Restaging bladder tumor resection improves staging accuracy and the response to intravesical therapy. However, its use outside of a tertiary care setting, and its subsequent clinical implications, are unknown.
  
  
  METHODS
  We identified 62 016 patients diagnosed with bladder cancer between 1992 and 2005 using SEER-Medicare data. Restaging bladder tumor resection was defined as 2 or more resections occurring within 60 days of diagnosis. Using multivariable models, we assessed the relationship between the use of restaging resection and cancer-specific survival.
  
  
  RESULTS
  Restaging resection was performed in only 3064 (4.9%) of newly diagnosed bladder cancer patients, but was most common among those with high grade (7.7% vs 2.0% in low grade, P < .001) and stage (8.8% in T2 vs 2.8% in Ta/Tis, P < .001) disease. Compared to patients with muscle-invasive cancers who did not undergo restaging at diagnosis, restaging resection was associated with improved 5-year cancer-specific mortality among pathologically staged patients (20.4% vs 28.0%, P = .02), while clinically staged patients trended toward improved mortality (28.2% vs 31.9%, P = .07).
  
  
  CONCLUSIONS
  Restaging transurethral resection for bladder cancer is relatively uncommon and associated with improved survival among patients with muscle invasive bladder cancer. Greater use of restaging warrants further investigation as a simple means of improving outcomes among patients suspected of having muscle invasive disease.
authors: Department of Urology, Division of Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
authors: Ted A
authors: TA
authors: Skolarus
authors: Zaojun
authors: Z
authors: Ye
authors: Jeffrey S
authors: JS
authors: Montgomery
authors: Alon Z
authors: AZ
authors: Weizer
authors: Khaled S
authors: KS
authors: Hafez
authors: Cheryl T
authors: CT
authors: Lee
authors: David C
authors: DC
authors: Miller
authors: David P
authors: DP
authors: Wood
authors: James E
authors: JE
authors: Montie
authors: Brent K
authors: BK
authors: Hollenbeck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009367:Neoplasm Staging / Q000706:statistics & numerical data*; D018426:SEER Program / Q000706:statistics & numerical data; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery