Oncologic outcomes of transurethral resection versus laser excision for non-muscle invasive bladder cancer: a SEER retrospective cohort study.

BACKGROUND

Transurethral resection of bladder tumor (TURBT) remains the standard surgical approach for non-muscle invasive bladder cancer (NMIBC). However, whether newer laser-based/en bloc techniques translate into durable oncologic benefits beyond perioperative and specimen-quality advantages remains controversial, and population-level evidence on recurrence and progression-particularly among patients who subsequently recur-is limited. This study compared oncologic outcomes between TURBT and transurethral laser excision of bladder tumor (TULBT) in patients with NMIBC using the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS

In this SEER retrospective cohort, we identified first primary NMIBC [stage 0a/0is/I according to the American Joint Committee on Cancer (AJCC) 8th edition] with urothelial histologies (ICD-O-3: 8120/3, 8130/3, 8131/3) treated with TURBT or TULBT (SEER surgery codes 14, 24-25, 27). Variables included recurrence-free survival (RFS), demographics, tumor AJCC stage, tumor progression, and overall survival (OS). RFS was defined as the time from index diagnosis to a subsequent primary bladder cancer (BCA) under SEER multiple-primary rules; progression was defined as muscle-invasive bladder cancer (MIBC) (AJCC II-IV) at recurrence. As the primary analysis, multivariable logistic regression and Cox proportional hazards models were performed in the full cohort to evaluate tumor progression and OS, with 1:3 propensity score matching (PSM) used for sensitivity analyses.

RESULTS

A total of 682 patients were included (TULBT, n=56; TURBT, n=626). In the raw cohort, MIBC at recurrence was more frequent after TULBT (46.4% vs. 31.8%; P=0.03) and RFS was longer (median 38.5 vs. 11.0 months; P<0.001). In full-cohort multivariable models, treatment modality was not independently associated with progression to MIBC [adjusted odds ratio (OR) for TURBT vs. TULBT, 0.489; 95% confidence interval (CI), 0.119-2.006; P=0.32] or OS [adjusted hazard ratio (HR) for TULBT vs. TURBT, 0.644; 95% CI, 0.355-1.166; P=0.15]. Longer RFS was independently associated with improved OS (HR, 0.975; P<0.001), whereas older age (HR, 1.055; P<0.001) and recurrent MIBC stage (HR, 2.860; P<0.001) predicted poorer OS. Sensitivity analyses in the PSM cohort showed consistent results.

CONCLUSIONS

TULBT is associated with longer RFS than TURBT in NMIBC, albeit with no clear benefit in tumor progression. Its survival advantage likely stems from delaying recurrence. These findings are exploratory and hypothesis-generating and warrant validation in prospective multicenter studies.