Purpose: While the presence of residual disease at the time of radical cystectomy for bladder cancer is an established prognostic indicator, controversy remains regarding the importance of maximal transurethral resection prior to neoadjuvant chemotherapy. We characterized the influence of maximal transurethral resection on pathological and survival outcomes using a large, multi-institutional cohort.
Materials And Methods: We identified 785 patients from a multi-institutional cohort undergoing radical cystectomy for muscle-invasive bladder cancer after neoadjuvant chemotherapy. We employed bivariate comparisons and stratified multivariable models to quantify the effect of maximal transurethral resection on pathological findings at cystectomy and survival.
Results: Of 785 patients, 579 (74%) underwent maximal transurethral resection. Incomplete transurethral resection was more frequent in patients with more advanced clinical tumor (cT) and nodal (cN) stage ( < .001 and < .01, respectively), with more advanced ypT stage at cystectomy and higher rates of positive surgical margins ( .01 and < .05, respectively). In multivariable models, maximal transurethral resection was associated with downstaging at cystectomy (adjusted odds ratio 1.6, 95% CI 1.1-2.5). In Cox proportional hazards analysis, maximal transurethral resection was not associated with overall survival (adjusted HR 0.8, 95% CI 0.6-1.1).
Conclusions: In patients undergoing transurethral resection for muscle-invasive bladder cancer prior to neoadjuvant chemotherapy, maximal resection may improve pathological response at cystectomy. However, the ultimate effects on long-term survival and oncologic outcomes warrant further investigation.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/JU.0000000000003193 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Introduction And Aim: Benign prostatic hyperplasia (BPH) is the enlargement and overgrowth of the prostate leading to the compression of the urethra and resulting in obstruction to the outflow of urine. Prostatic urethral lift (UroLift) is a budding minimally invasive technique that utilises mechanical manipulation of the prostate tissue so that the urethra is free from compression, thereby creating a channel for the outflow of urine. The aim of the audit was to assess the short- to medium-term outcomes in our centre in terms of improvement in symptoms, quality of life (QoL) and complication rates.
View Article and Find Full Text PDFImmediate second resection versus restage transurethral resection of bladder tumor: A prospective randomized clinical trial (IMMERSE trial).
Urol Oncol
January 2025
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
Background: The role of repeat transurethral resection of bladder tumor (TURBT) for the management of nonmuscle invasive bladder carcinoma is debated, especially when initial resections include detrusor muscle. This study compares immediate second resection (additional deep biopsies in the same session) with standard restage TURBT performed 2-6 weeks post-initial TURBT to determine adequacy in detrusor muscle sampling and compare the disease rate at restage TURBT in both groups.
Material And Methods: A randomized trial was conducted at a tertiary care hospital, including patients aged ≥18 years undergoing TURBT with complete primary tumor resection.
Cost-utility analysis of MR imaging-guided transurethral ultrasound ablation for the treatment of low- to intermediate-risk localised prostate cancer.
BMJ Open
January 2025
Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
Background: Magnetic resonance-guided transurethral ultrasound ablation (MR-TULSA) is a new focal therapy for treating localised prostate cancer that is associated with fewer adverse effects (AEs) compared with established treatments. To support large-scale clinical implementation, information about cost-effectiveness is required.
Objective: To evaluate the cost-utility of MR-TULSA compared with robot-assisted radical prostatectomy (RARP), external beam radiation therapy (EBRT) and active surveillance (AS) for patients with low- to favourable intermediate-risk localised prostate cancer.
A comparison between intravesical gemcitabine plus docetaxel and intravesical BCG in the treatment of non-muscle invasive naive urinary bladder cancer: A systematic review and meta-analysis of oncological outcomes.
Urology
January 2025
Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Objective: To evaluate the efficacy, recurrence rates, and safety profile of intravesical gemcitabine plus docetaxel versus standard Bacillus Calmette-Guérin (BCG) therapy for treating naïve non-muscle-invasive bladder cancer (NMIBC), focusing on reducing recurrence and progression concerns associated with transurethral resection (TURBT).
Methods: Relevant articles were identified and appraised through a structured assessment of the literature. Databases searched included PubMed, Medline, Scopus, and Science Direct.
Feasibility and Oncological Outcome of Patients Achieving Noninvasive Downstaging After Transurethral Resection of Bladder Tumor Plus Systemic Chemotherapy for Bladder Preservation Strategy in Muscle-Invasive Bladder Cancer.
Clin Genitourin Cancer
December 2024
Department of Urology, Mie University hospital, Tsu, Japan.
Article Synopsis
- The study aimed to assess the outcomes of bladder preservation therapy combining maximal TURBT and neoadjuvant chemotherapy in muscle-invasive bladder cancer patients.
- A total of 110 patients were treated, with 61 achieving noninvasive downstaging, allowing them to preserve their bladders.
- The findings indicated that bladder preservation therapy had comparable survival rates to radical cystectomy, but more research is necessary to confirm these results due to the retrospective nature of the study.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!