Complete transurethral resection of bladder tumor (TURBT) prior to neoadjuvant chemotherapy (NAC) may improve oncological outcomes and survival in patients with muscle-invasive bladder cancer (MIBC), investigators reported at the 20th annual meeting of the Society of Urologic Oncology in Washington, DC.

Jamie Pak, MD, of Columbia University Irving Medical Center in New York, and colleagues studied 93 patients with clinically localized MIBC (cT2 or higher, N0) from a single institution who underwent TURBT followed by NAC during 2000 to 2017. Of these, 62 received complete TURBT, defined as resection of the entire tumor or down to normal-appearing bladder muscle with confirmatory imaging. After NAC, patients underwent a repeat TURBT, radical cystectomy, or active surveillance (AS) and delayed intervention, including cytology, cystoscopy with or without biopsy, and cross-sectional imaging at 3- to 4-month intervals.

Patients with complete TURBT were significantly less likely to have variant histology (13% vs 32%) and hydronephrosis (15% vs 39%) and were significantly more likely to adopt AS and delayed intervention (60% vs 26%). On univariate analysis, complete pre-NAC TURBT was significantly associated with 4-fold greater odds of a durable complete response (pT0 or cT0 on AS for at least 1 year) and nearly 5-fold greater odds of durable down-staging (pT1 or cT1 or less).

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On multivariate analysis, complete TURBT significantly predicted both durable complete response and downstaging. In addition, patients with complete TURBT had significantly better overall survival at 5 years: 78% vs 46%. Also on multivariate analysis, complete TURBT was the sole predictor of overall survival after adjusting for variant histology, lymphovascular invasion, and hydronephrosis.

Whether complete TURBT confers these benefits or simply serves as a marker of amenable disease is still unclear.

“The extent to which a complete pre-NAC TURBT represents a selection criterion for having lower clinical stage or a therapeutic advantage in response to NAC is difficult to isolate from a retrospective study,” Dr Pak’s team stated in their study abstract. “However, this report suggests a complete TURBT of muscle-invasive tumors should be pursued when feasible to potentially optimize outcomes after NAC.”

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Pak J, Haas C, Anderson C, et al. Complete TURBT prior to neoadjuvant chemotherapy improves oncological outcomes in patients with muscle-invasive bladder cancer. Presented at the 20th annual meeting of the Society of Urologic Oncology held December 4 to 6, 2019, in Washington DC. Poster #7.