Therapeutic and prognostic value of repeat transurethral resection for high-grade Ta bladder cancer: a propensity score matching analysis.

High-grade Ta bladder cancer, although anatomically confined to the mucosa, exhibits aggressive biological behavior with high recurrence rate and progression risks. The role of repeat transurethral resection of bladder tumor (Re-TURBT) in this specific population remains controversial. This retrospective cohort study aimed to evaluate the therapeutic and prognostic value of Re-TURBT for high-grade Ta non-muscle-invasive bladder cancer (NMIBC) using propensity score matching (PSM) analysis. A total of 324 patients with pathologically confirmed high-grade Ta urothelial carcinoma who underwent initial TURBT from January 2014 to June 2023 were included in this study. Among them, 196 underwent Re-TURBT within 2-6 weeks, whereas 128 did not. PSM was performed in a 1:1 ratio using a caliper width of 0.10, resulting in 70 matched pairs with comparable baseline characteristics. Recurrence-free survival (RFS) was defined as primary outcome. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and the residual tumor detection rate. In the Re-TURBT group, residual tumor was detected in 29.6% of patients, with pathological upstaging observed in 8.6% of cases (7.1% to T1 and 1.5% to T2). The Re-TURBT group showed significantly lower recurrence rates (14.3% vs. 50.0%; P<0.001) and progression rates (4.3% vs. 15.7%; P=0.024). Cox regression identified Re-TURBT as an independent protective factor for RFS (HR=0.217, 95% CI: 0.107-0.439, P<0.001) and PFS (HR=0.253, 95% CI: 0.070-0.906, P=0.023); however, Re-TURBT was not significantly associated with OS (P=0.854). Subgroup analyses revealed that the benefits of Re-TURBT were particularly pronounced in patients with larger tumors (>3.2 cm) and those not receiving BCG maintenance therapy. The overall complication rate was 6.12%. All complications were mild to moderate and were managed conservatively. To sum up, in patients with high grade Ta bladder cancer, Re-TURBT significantly reduces the risks of recurrence and progression and should be considered an integral component of high-risk NMIBC management, particularly for patients with larger tumors or suboptimal BCG maintenance therapy.