Complete transurethral resection of bladder tumor (TURBT) prior to neoadjuvant chemotherapy for muscle-invasive bladder cancer (MIBC) is associated with improved survival and oncologic outcomes following radical cystectomy, according to investigators.
A retrospective single-institution study of 93 patients with MIBC demonstrated that patients who underwent complete TURBT before neoadjuvant chemotherapy (NAC) had significantly higher 5-year rates of overall survival (77% vs 46%) and cancer-specific survival (85% vs 50%) compared with those who had incomplete TURBT, Jamie S. Pak, MD, of Columbia University Irving Medical Center in New York City, and colleagues reported in Urologic Oncology. They also had significantly higher rates of recurrence-free survival (24% vs 6%) and muscle-invasive recurrence-free survival (59% vs 14%).
The investigators defined complete TURBT as resection of all visible tumor in its entirety, resection to normal-appearing muscle, and/or repeat pre-NAC TURBT.
“A visibly complete TURBT prior to NAC was associated with better oncologic outcomes in this single institutional cohort of patients with MIBC,” the authors concluded. “The extent to which a complete pre-NAC TURBT represents a proxy for less aggressive disease or a therapeutic advantage in response to NAC is difficult to define from a retrospective study.”
Of the 93 patients in the study, 62 (67%) underwent complete TURBT prior to NAC. These patients had lower rates of variant histology (13% vs 32%) and hydronephrosis (15% vs 39%) compared with patients who had incomplete TURBT.
No patients in the complete TURBT group had cT3 or greater disease compared with 36% of patients with incomplete TURBT. Those with complete TURBT had lower rates of pT2 or higher disease at cystectomy (48% vs 75%).
Pak JS, Haas CR, Anderson CB, DeCastro GJ, Benson MC, McKiernan JM. Survival and oncologic outcomes of complete transurethral resection of bladder tumor prior to neoadjuvant chemotherapy for muscle-invasive bladder cancer. Urol Oncol. Published online April 14, 2021. doi:10.1016/j.urolonc.2021.03.025