title: Second-look resection for primary stage T1 bladder cancer: a population-based study.
abstract: OBJECTIVE
  This study aimed to evaluate the use of second-look resection (SLR) in stage T1 bladder cancer (BC) in a population-based Swedish cohort.
  
  
  METHODS
  All patients diagnosed with stage T1 BC in 2008-2009 were identified in the Swedish National Registry for Urinary Bladder Cancer. Registry data on TNM stage, grade, primary treatment and pathological reports from the SLR performed within 8 weeks of the primary transurethral resection were validated against patient charts. The endpoint was cancer-specific survival (CSS).
  
  
  RESULTS
  In total, 903 patients with a mean age of 74 years (range 28-99 years) were included. SLR was performed in 501 patients (55%), who had the following stages at SLR: 172 (35%) T0, 83 (17%) Ta/Tis, 210 (43%) T1 and 26 (5%) T2-4. The use of SLR varied from 18% to 77% in the six healthcare regions. Multiple adjuvant intravesical instillations were given to 420 patients (47%). SLR was associated with intravesical instillations, age younger than 74 years, discussion at multidisciplinary tumour conference, G3 tumour and treatment at high-volume hospitals. Patients undergoing SLR had a lower risk of dying from BC (hazard ratio 0.62, 95% confidence interval 0.45-0.84, p < .0022). Five-year CSS rates were as follows, in patients with the indicated tumours at SLR (p = .001): 82% in those with T1, 90% in T0, 90% in Ta/Tis and 56% in T2-4.
  
  
  CONCLUSIONS
  There are large geographical differences in the use of SLR in stage T1 BC in Sweden, which are presumably related to local treatment traditions. Patients treated with SLR have a high rate of residual tumour but lower age, which suggests that a selection bias affects CSS.
authors.affiliation: a Department of Translational Medicine , Lund University and Department of Urology, Skåne University Hospital , Malmö , Sweden.
authors.forename: Oliver
authors.initials: O
authors.lastname: Patschan
authors.affiliation: b Department of Urology , Sahlgrenska University Hospital , Göteborg , Sweden.
authors.forename: Sten
authors.initials: S
authors.lastname: Holmäng
authors.affiliation: c Department of Urology , Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Hosseini
authors.affiliation: a Department of Translational Medicine , Lund University and Department of Urology, Skåne University Hospital , Malmö , Sweden.
authors.forename: Georg
authors.initials: G
authors.lastname: Jancke
authors.affiliation: a Department of Translational Medicine , Lund University and Department of Urology, Skåne University Hospital , Malmö , Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Liedberg
authors.affiliation: d Department of Surgical and Perioperative Sciences, Urology and Andrology , Umeå University , Umeå , Sweden.
authors.forename: Börje
authors.initials: B
authors.lastname: Ljungberg
authors.affiliation: e Department of Urology , Akademiska University Hospital , Uppsala , Sweden.
authors.forename: Per-Uno
authors.initials: PU
authors.lastname: Malmström
authors.affiliation: f Regional Cancer Center Southeast Sweden and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Rosell
authors.affiliation: g Department of Urology , University Hospital and IKE, Linköping University , Linköping , Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Jahnson
mesh_terms: D000283:Administration, Intravesical; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D005260:Female; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012042:Registries; D024162:Second-Look Surgery / Q000706:statistics & numerical data*; D015996:Survival Rate; D013548:Sweden; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*
keywords: Bladder cancer; cancer-specific survival; population-based; second-look resection; stage T1