title: Significance of the interval between first and second transurethral resection on recurrence and progression rates in patients with high-risk non-muscle-invasive bladder cancer treated with maintenance intravesical Bacillus Calmette-Guérin.
abstract: OBJECTIVE
  To evaluate the effect of the interval between the initial and second transurethral resection (TUR) on the outcome of patients with high-risk non-muscle-invasive bladder cancer (NMIBC) treated with maintenance intravesical Bacillus Calmette-Guérin (BCG) therapy.
  
  
  METHODS
  We reviewed the data of patients from 10 centres treated for high-risk NMIBC between 2005 and 2012. Patients without a diagnosis of muscle-invasive cancer on second TUR performed ≤90 days after a complete first TUR, and received at least 1 year of maintenance BCG were included in this study. The interval between first and second TUR in addition to other parameters were recorded. Multivariate logistic regression analysis was used to identify predictors of recurrence and progression.
  
  
  RESULTS
  In all, 242 patients were included. The mean (sd, range) follow-up was 29.4 (22.2, 12-96) months. The 3-year recurrence- and progression-free survival rates of patients who underwent second TUR between 14 and 42 days and 43-90 days were 73.6% vs 46.2% (P < 0.001) and 89.1% vs 79.1% (P = 0.006), respectively. On multivariate analysis, the interval to second TUR was found to be a predictor of both recurrence [odds ratio (OR) 3.598, 95% confidence interval (CI) 1.885-8.137; P = 0.001] and progression (OR 2.144, 95% CI 1.447-5.137; P = 0.003).
  
  
  CONCLUSIONS
  The interval between first and second TUR should be ≤42 days in order to attain lower recurrence and progression rates. To our knowledge, this is the first study demonstrating the effect of the interval between first and second TUR on patient outcomes.
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Sümer
authors.initials: S
authors.lastname: Baltacı
authors.affiliation: Department of Urology, University of Mersin School of Medicine, Mersin, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Bozlu
authors.affiliation: Department of Urology, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey.
authors.forename: Asıf
authors.initials: A
authors.lastname: Yıldırım
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Mehmet İlker
authors.initials: Mİ
authors.lastname: Gökçe
authors.affiliation: Department of Urology, Marmara University School of Medicine, İstanbul, Turkey.
authors.forename: İlker
authors.initials: İ
authors.lastname: Tinay
authors.affiliation: Department of Urology, Dokuz Eylül University School of Medicine Inciralti, Izmir, Turkey.
authors.forename: Güven
authors.initials: G
authors.lastname: Aslan
authors.affiliation: Department of Urology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey.
authors.forename: Cavit
authors.initials: C
authors.lastname: Can
authors.affiliation: Department of Urology, Marmara University School of Medicine, İstanbul, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Türkeri
authors.affiliation: Department of Urology, Trakya University School of Medicine, Edirne, Turkey.
authors.forename: Uğur
authors.initials: U
authors.lastname: Kuyumcuoğlu
authors.affiliation: Department of Urology, Bülent Ecevit University School of Medicine, Zonguldak, Turkey.
authors.forename: Aydın
authors.initials: A
authors.lastname: Mungan
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000008:administration & dosage*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control*; D055502:Secondary Prevention / Q000379:methods; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine
keywords: Bacillus Calmette-Guérin; maintenance Bacillus Calmette-Guérin; non-muscle-invasive bladder cancer; second transurethral resection