Is complete TURBT mandatory before radical cystectomy in cases of muscle-invasive bladder cancer?

OBJECTIVE

To study the impact of complete transurethral resection of bladder tumor (TURBT) on survival outcomes for patients of muscle-invasive bladder carcinoma (MIBC) undergoing upfront or post-NACT (neo-adjuvant chemotherapy) radical cystectomy (RC) and to identify the factors that contribute to achieving a complete TURBT (cTURBT).

METHODS

A retrospective analysis of 244 cases of bladder cancer that underwent RC at our institute between 2013 and 2019 was undertaken. Univariate logistic regression analysis was used to identify factors that could affect the performance of cTURBT. The factors significant on univariate analysis were further subjected to multivariate logistic analysis. Survival univariate analysis was performed using the Kaplan-Meier curve analysis method. Cox regression analysis was used to identify the factors that affected cancer specific survival (CSS).

RESULTS

In multivariate logistic analysis, tumor sizes of 3 to 5 cm (HR 3.5) and greater than 5 cm (HR 11.2) were significantly linked to residual tumor at TURBT, as was clinical T-stage greater than 3 (HR 5.2). Hydroureteronephrosis (HUN) (HR 2.9), variant histology (HR 2.2), incomplete TURBT (icTURBT) (HR 1.7), pathological T-stage (HR 1.2), pathological N-stage (HR 2.0), and NACT (HR 0.2) were identified as independent predictors of CSS in Cox survival analysis. cTURBT improved CSS (36 months) compared to icTURBT (17 months) in patients who did not receive NACT (log-rank test P = 0.001). No survival difference was observed when NACT was administered.

CONCLUSION

Tumor size > 3 cm and T-stage >/ = cT3 were significantly associated with icTURBT. cTURBT improved CSS in patients subjected to upfront cystectomy but not in patients subjected to NACT before RC.