Absence of Tumor on Repeat Transurethral Resection of Bladder Tumor Does Not Predict Final Pathologic T0 Stage in Bladder Cancer Treated with Radical Cystectomy.

BACKGROUND: For patients with bladder cancer (BC) receiving neoadjuvant chemotherapy (NAC), complete pathologic absence of tumor (pT0) at radical cystectomy (RC) is associated with better survival. It is unclear if pT0 status can be attributed to the absence of residual disease (cT0) on transurethral resection of bladder tumor (TURBT) or to the effects of NAC. OBJECTIVE: To determine how often cT0 is associated with pT0 and identify preoperative and postoperative factors associated with survival. DESIGN, SETTING, AND PARTICIPANTS: Between 1995 and 2011, 157 out of 1897 RC patients were identified as stage cT0 after at least two TURBT procedures at a single center. INTERVENTION: RC with or without NAC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Initial TURBT pathology and clinical staging were reviewed. The primary endpoint was pathologic stage at RC. Cox proportional hazards ratios identified factors associated with residual disease at RC, overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS). RESULTS AND LIMITATIONS: Of the cT0 patients, 49.7% (n=78) underwent NAC. pT0 was found in 35.7% (n=56). Residual tumor was found at RC in 63.7% (n=101), of whom 24.8% (n=39) had advanced disease (≥pT3 or node-positive disease). Positive lymph nodes at RC were found in 12.7% (n=20) of the patients. There was no significant difference in achieving pT0 status between patients with and without NAC. The presence of advanced BC was most predictive of OS. NAC was associated with longer OS and RFS. During median follow-up of 6.3 yr, the 5-yr RFS was 81% for those with non-advanced disease and 46% for advanced BC (p<0.001). The 5-yr OS rate was 77% for non-advanced BC and 46% for invasive BC (p<0.001). Limitations include the retrospective design. CONCLUSIONS: Complete TURBT does not predict pT0 at RC. A notable fraction of patients with cT0 bladders have locally advanced and/or lymph node-positive disease. These findings may be of value when counseling patients on bladder preservation strategies for muscle-invasive BC. PATIENT SUMMARY: Among patients thought to have had the entire tumor in their bladder removed via cystoscopy, a majority have persistent tumors when their bladders were removed. In a sizable proportion, these persistent tumors were even more invasive than initially thought.

Duke Scholars

Author Vishnukamal Golla Urology