title: The effect of restaging transurethral resection on recurrence and progression rates in patients with nonmuscle invasive bladder cancer treated with intravesical bacillus Calmette-Guérin.
abstract: OBJECTIVE
  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.
  
  
  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.
authors: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: sfakianj@mskcc.org.
authors: John P
authors: JP
authors: Sfakianos
authors: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Philip H
authors: PH
authors: Kim
authors: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: A Ari
authors: AA
authors: Hakimi
authors: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Harry W
authors: HW
authors: Herr
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D001500:BCG Vaccine / Q000008:administration & dosage / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D012086:Reoperation; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*
chemical_list: D001500:BCG Vaccine
keywords: BCG; BCG vaccine; CIS; NMIBC; TUR; bacillus Calmette-Guérin; carcinoma; carcinoma in situ; local; neoplasm recurrence; nonmuscle invasive bladder carcinoma; reoperation; transurethral resection; urinary bladder
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