title: The impact of re-transurethral resection on clinical outcomes in a large multicentre cohort of patients with T1 high-grade/Grade 3 bladder cancer treated with bacille Calmette-Guérin.
abstract: OBJECTIVE
  To determine if a re-transurethral resection (TUR), in the presence or absence of muscle at the first TUR in patients with T1-high grade (HG)/Grade 3 (G3) bladder cancer, makes a difference in recurrence, progression, cancer specific (CSS) and overall survival (OS).
  
  
  METHODS
  In a large retrospective multicentre cohort of 2451 patients with T1-HG/G3 initially treated with bacille Calmette-Guérin, 935 (38%) had a re-TUR. According to the presence or absence of muscle in the specimen of the primary TUR, patients were divided in four groups: group 1 (no muscle, no re-TUR), group 2 (no muscle, re-TUR), group 3 (muscle, no re-TUR) and group 4 (muscle, re-TUR). Clinical outcomes were compared across the four groups.
  
  
  RESULTS
  Re-TUR had a positive impact on recurrence, progression, CSS and OS only if muscle was not present in the primary TUR specimen. Adjusting for the most important prognostic factors, re-TUR in the absence of muscle had a borderline significant effect on time to recurrence [hazard ratio (HR) 0.67, P = 0.08], progression (HR 0.46, P = 0.06), CSS (HR 0.31, P = 0.07) and OS (HR 0.48, P = 0.05). Re-TUR in the presence of muscle in the primary TUR specimen did not improve the outcome for any of the endpoints.
  
  
  CONCLUSIONS
  Our retrospective analysis suggests that re-TUR may not be necessary in patients with T1-HG/G3, if muscle is present in the specimen of the primary TUR.
authors.affiliation: Urology Clinic, Città della Salute e della Scienza di Torino, University of Studies of Turin, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
authors.affiliation: Formerly Department of Biostatistics, EORTC Headquarters, Brussels, Belgium.
authors.forename: Richard
authors.initials: R
authors.lastname: Sylvester
authors.affiliation: Urology Clinic, Città della Salute e della Scienza di Torino, University of Studies of Turin, Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pisano
authors.affiliation: Oncologic and Reconstructive Urology, Department of Urology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Joniau
authors.affiliation: Urology Clinic, Città della Salute e della Scienza di Torino, University of Studies of Turin, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Oderda
authors.affiliation: Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Serretta
authors.affiliation: Department of Surgical Science, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Larré
authors.affiliation: Policlinico Tor Vergata-University of Rome, Rome, Italy.
authors.forename: Savino
authors.initials: S
authors.lastname: Di Stasi
authors.affiliation: Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: Van Rhijn
authors.affiliation: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Alfred J
authors.initials: AJ
authors.lastname: Witjes
authors.affiliation: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Grotenhuis
authors.affiliation: Dipartimento di Urologia, Università Vita-Salute. Ospedale S. Raffaele, Milan, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.affiliation: Dipartimento di Urologia, Università Vita-Salute. Ospedale S. Raffaele, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Department of Urology, Motol Hospital, University of Praha, Praha, Czech Republic.
authors.forename: Marek
authors.initials: M
authors.lastname: Babjuk
authors.affiliation: Department of Urology, Motol Hospital, University of Praha, Praha, Czech Republic.
authors.forename: Viktor
authors.initials: V
authors.lastname: Soukup
authors.affiliation: Department of Urology, Academic Hospital, Uppsala University, Uppsala, Sweden.
authors.forename: Per-Uno
authors.initials: PU
authors.lastname: Malmström
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire La Milétrie, University of Poitiers, Poitiers, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Irani
authors.affiliation: Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Malats
authors.affiliation: Department of Urology, Rabin Medical Centre, Tel Aviv, Israel.
authors.forename: Jack
authors.initials: J
authors.lastname: Baniel
authors.affiliation: Department of Urology, Rabin Medical Centre, Tel Aviv, Israel.
authors.forename: Roy
authors.initials: R
authors.lastname: Mano
authors.affiliation: Department of Urology, Santa Chiara Hospital, Trento, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Cai
authors.affiliation: Department of Urology, Weill Medical College of Cornell University in New York City, New York, NY, USA.
authors.forename: Eugene K
authors.initials: EK
authors.lastname: Cha
authors.affiliation: Facharzt fur Urologie, Abteilung fur Urologie. Chirurgische Universitats klinik, Freiburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Ardelt
authors.affiliation: Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Vakarakis
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bartoletti
authors.affiliation: Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Guido
authors.initials: G
authors.lastname: Dalbagni
authors.affiliation: Department of Urology, Weill Medical College of Cornell University in New York City, New York, NY, USA.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Department of Urology, Weill Medical College of Cornell University in New York City, New York, NY, USA.
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Karnes
authors.affiliation: Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Palou
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000368:Aged; D001500:BCG Vaccine / Q000627:therapeutic use*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine
keywords: T1G3; bladder cancer; high grade; progression; re-TUR; recurrence