The Impact of Restaging Transurethral Resection of Bladder Tumor on Survival Parameters in T1 Nonmuscle-Invasive Bladder Cancer: Systematic Review and Meta-Analysis
Abstract
Background: T1, high-grade, nonmuscle-invasive bladder cancer (NMIBC) is characterized by a high recurrence rate and progression to muscle-invasive disease concerns a significant number of patients. To overcome limitations of initial transurethral resection of bladder tumor (TURBT), various strategies are proposed in the literature. One of them is performance of restaging TURBT (re-TURBT). In recent years, it has been shown that re-TURBT can provide valuable additional pathologic information. However, its potential effect on survival improvement is debatable and benefits from this procedure have been suggested to be dependent on several clinicopathological factors (e.g., the presence of detrusor muscle in initial TURBT).
Evidence Acquisition: A systematic search was conducted within the three electronic databases, including Medline, Scopus, and Embase. The following outcomes were retrieved: outcome measurements of recurrence-free survival (RFS), progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS), including hazard ratios and 95% confidence intervals. Initially, a main analysis for each outcome (RFS, PFS, CSS, and OS) was performed. Subsequently, we conducted subgroup analyses for the following factors: T1 grade, presence of detrusor muscle in initial TURBT, and type of adjuvant intravesical therapy.
Evidence Synthesis: Finally, six studies with overall 3257 participants were identified for this meta-analysis. A significant impact of re-TURBT on RFS, PFS, CSS, and OS was not found in the overall analysis that included all patients with T1 bladder tumors. On the other hand, subgroup analyses, including studies reporting cohorts with mixed T1 tumor grading, revealed that re-TURBT was associated with significantly better RFS, PFS, and OS.
Conclusions: This meta-analysis shows that re-TURBT does not improve survival outcomes in patients with T1 tumors; however, results of some particular subgroup analyses indicate its potential positive impact on the subsequent course of the disease. Furthermore, high-quality, prospective, randomized controlled trials are necessary to make a final statement about the therapeutic role of re-TURBT in T1 NMIBC.
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References
1. Ferlay J, Colombet M, Soerjomataram I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer 2019;144:1941–1953.
2. Babjuk M, Burger M, Compérat EM, et al. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ)-2019 Update. Eur Urol 2019;76:639–657.
3. van Rhijn BW, Burger M, Lotan Y, et al. Recurrence and progression of disease in non-muscle-invasive bladder cancer: From epidemiology to treatment strategy. Eur Urol 2009;56:430–442.
4. Mariappan P, Smith G, Lamb AD, Grigor KM, Tolley DA. Pattern of recurrence changes in noninvasive bladder tumors observed during 2 decades. J Urol 2007;177:867–875.
5. Oddens J, Brausi M, Sylvester R, et al. Final results of an EORTC-GU cancers group randomized study of maintenance bacillus Calmette-Guérin in intermediate- and high-risk Ta, T1 papillary carcinoma of the urinary bladder: One-third dose versus full dose and 1 year versus 3 years of maintenance. Eur Urol 2013;63:462–472.
6. van den Bosch S, Alfred Witjes J. Long-term cancer-specific survival in patients with high-risk, non-muscle-invasive bladder cancer and tumour progression: A systematic review. Eur Urol 2011;60:493–500.
7. Schraml J, Silva JDC, Babjuk M. Current concept of transurethral resection of bladder cancer: From re-transurethral resection of bladder cancer to en-bloc resection. Curr Opin Urol 2018;28:591–597.
8. Liem EI, de Reijke TM. Can we improve transurethral resection of the bladder tumour for nonmuscle invasive bladder cancer? Curr Opin Urol 2017;27:149–155.
9. Yun SJ, Kim SK, Kim WJ. How do we manage high-grade T1 bladder cancer? Conservative or aggressive therapy? Investig Clin Urol 2016;57 Suppl 1(Suppl 1):S44–S51.
10. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. Open Med 2009;3:e123–e130.
11. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010;25:603–605.
12. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 1996;17:1–12.
13. Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 2007;8:16.
14. Angulo JC, Palou J, García-Tello A, de Fata FR, Rodríguez O, Villavicencio H. Second transurethral resection and prognosis of high-grade non-muscle invasive bladder cancer in patients not receiving bacillus Calmette-Guérin. Actas Urol Esp 2014;38:164–171.
15. Calò B, Chirico M, Fortunato F, et al. Is repeat transurethral resection always needed in high-grade T1 bladder cancer? Front Oncol 2019;9:465.
16. Eroglu A, Ekin RG, Koc G, Divrik RT. The prognostic value of routine second transurethral resection in patients with newly diagnosed stage pT1 non-muscle-invasive bladder cancer: Results from randomized 10-year extension trial. Int J Clin Oncol 2020;25:698–704.
17. Gontero P, Sylvester R, Pisano F, et al. 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. BJU Int 2016;118:44–52.
18. Krajewski W, Zdrojowy R, Kościelska-Kasprzak K, et al. Does restaging transurethral resection of bladder tumour influence outcomes in patients treated with BCG immunotherapy? 491 cases in 20 years' experience. Wideochir Inne Tech Maloinwazyjne 2019;14:284–296.
19. Tseng WH, Liu CL, Huang SK, et al. Therapeutic benefit of second-look transurethral resection of bladder tumors for newly diagnosed T1 bladder cancer: A single-center experience. Int Urol Nephrol 2019;51:1335–1342.
20. Mikulowski P, Hellsten S. T1 G1 urinary bladder carcinoma: Fact or fiction? Scand J Urol Nephrol 2005;39:135–137.
21. Novara G, Ficarra V. Does routine second transurethral resection affect the long-term outcome of patients with T1 bladder cancer? Why a flawed randomized controlled trial cannot address the issue. Eur Urol 2010;58:193–194.
22. Sfakianos JP, Kim PH, Hakimi AA, Herr HW. The effect of restaging transurethral resection on recurrence and progression rates in patients with nonmuscle invasive bladder cancer treated with intravesical bacillus Calmette-Guérin. J Urol 2014;191:341–345.
23. Kim W, Song C, Park S, et al. Value of immediate second resection of the tumor bed to improve the effectiveness of transurethral resection of bladder tumor. J Endourol 2012;26:1059–1064.
24. Soria F, Marra G, D'Andrea D, Gontero P, Shariat SF. The rational and benefits of the second look transurethral resection of the bladder for T1 high grade bladder cancer. Transl Androl Urol 2019;8:46–53.
25. Cumberbatch MGK, Foerster B, Catto JWF, et al. Repeat transurethral resection in non-muscle-invasive bladder cancer: A systematic review. Eur Urol 2018;73:925–933.
26. Naselli A, Hurle R, Paparella S, et al. Role of restaging transurethral resection for T1 non-muscle invasive bladder cancer: A systematic review and meta-analysis. Eur Urol Focus 2018;4:558–567.
27. Naito S, Algaba F, Babjuk M, et al. The Clinical Research Office of the Endourological Society (CROES) Multicentre Randomised Trial of Narrow Band Imaging-Assisted Transurethral Resection of Bladder Tumour (TURBTTT) Versus Conventional White Light Imaging-Assisted TURBTTT in Primary Non-Muscle-invasive Bladder Cancer Patients: Trial Protocol and 1-year Results. Eur Urol 2016;70:506–515.
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Copyright 2020, Mary Ann Liebert, Inc., publishers.
History
Published online: 17 August 2020
Published in print: August 2020
Published ahead of print: 3 June 2020
Published ahead of production: 25 April 2020
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The authors listed have made substantial contributions to the intellectual content of the article in the various sections described below: (a) conception and design: W.K., M.M., and E.X.; (b) acquisition of data: W.K., Ł.N., P.K., and M.W.; (c) analysis and interpretation of data: W.K., Ł.N., and S.P.; (d) drafting of the manuscript: W.K., Ł.N., M.M., and S.P.; (e) critical revision of the manuscript for important intellectual content: M.M., E.X., R.Z., A.M., and E.D.T.; (f) statistical analysis: A.T. and Ł.N.; and (g) administrative, technical, or material support: A.M. and E.D.T.
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None of the contributing authors have any conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the article.
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