Is There A Benefit of Restaging Transurethral Resection of Bladder Tumor Prior to Radical Cystectomy With or Without Neoadjuvant Chemotherapy?

BACKGROUND

One of the best predictors of positive outcomes in bladder cancer (BC) is pT0 following radical cystectomy (RC). Discordance between clinical and pathologic staging affects decision-making in patients with clinical absence of disease (cT0).

OBJECTIVES

We sought to determine whether a restaging transurethral resection of bladder tumor (re-TURBT) improves clinical staging accuracy relative to pathologic stage RC in patients treated with neoadjuvant chemotherapy (NAC) versus those who did not receive NAC.

METHODS

We queried our prospectively maintained IRB approved institutional database to identify 129 patients who underwent RC from 2013 to 2019 with a re-TURBT prior to RC. 53 patients were treated with NAC between their initial and re-TURBT and 76 patients were not treated with NAC.

RESULTS

The overall upstaging rate from re-TURBT to RC was 34.9%. There was no significant difference in the upstaging rate between the NAC and no-NAC groups - 31.0% vs. 37.0%, respectively. In patients who were cT0 on re-TURBT, the NAC group did not show a significantly greater rate of pathologic clinical CR (pT0) than the no NAC group - 38.5% vs. 37.5%, respectively. Re-TURBT with staging < rT2 as a predictor for absence of MIBC on pathologic staging (<ypT2) did not show a significant difference between the NAC and no NAC group, with a negative predictive value (NPV) of 69.0% and 66.7%, respectively.

CONCLUSIONS

Re-TURBT after NAC does not show statistically significant improvement in staging accuracy relative to pathologic stage at RC compared to re-TURBT in patients not treated with NAC.