Key strategies for reducing recurrence in T1 bladder cancer. Evidence from a retrospective multicenter European study.

Abstract

Introduction: To evaluate whether adherence to specific quality criteria in the management of T1 non-muscle-invasive bladder cancer (NMIBC) undergoing second-look transurethral resection of bladder tumor (TURBT) leads to improved oncological outcomes.

Materials and methods: A retrospective multicenter study included patients diagnosed between 2015 and 2021 with high or very-high-risk a NMIBC after initial TURBT, followed by second-look TURBT and Bacillus Calmette-Guérin (BCG) adjuvant therapy. Key management steps assessed included enhanced tumor visualization, complete resection, timing of second look, detrusor muscle presence in specimens, and adequate BCG therapy. The primary endpoint was bladder recurrence-free survival (RFS), analyzed using Kaplan-Meier curves and Cox regression models.

Results: Among 226 patients included, the median age was 73(65-79) years, and 49 were classified in the very high-risk group (22%). Second-look TURBT was performed with a median delay of 8 (6-10) weeks. Factors significantly impacting 3-year RFS included adequate BCG exposure (HR = 0.55; 95% CI 0.32-0.93; p = 0.03) and the presence of residual tumor at second-look TURBT (HR = 2.55; 95% CI 1.48-4.39; p < 0.001). Neither the use of photodynamic diagnostics nor timing beyond 6 weeks for second-look TURBT significantly influenced outcomes (p > 0.05).

Conclusions: In T1 NMIBC, adequate BCG therapy and absence of residual tumor at second-look TURBT are the primary predictors of 3-year RFS. These findings emphasize the importance of quality management in TURBT procedures and patient treatment.