Predictors of residual tumor at re-staging transurethral resection for high-risk non-muscle invasive bladder cancer

Author of the Study: Re-staging transurethral resection of bladder tumor re-TURBt is nowadays considered the gold-standard treatment for patients with non-muscle invasive bladder cancer (NMIBC) harboring high-risk features. Although the rationale behind it’s well established in the current guidelines, it must be considered its potential morbidity, procedure-related costs and the need of general or locoregional anesthesia. To assess a risk-adapted strategy, we analyzed the role of clinicopathological, laboratory and surgical predictors of residual tumor at the time of re-TURBt in a single- Institution series of T1 NIMIBC. Materials and Methods: A prospectively maintained internal databasewas queried. Data about 114 consecutive patients who underwent re-TURBt for T1 NMIBC were analyzed. Binomial logistic regression models were applied to evaluate residual tumor predictors. Step function was used to select the best model according to the Akaike Information Criterion (AIC). Results: Of these 114 patients, 97 were men (85.1%) and 17 were women (14.9%). The median age of the participants at the time of the interventionswas 73 years (IQR 68–79). Regarding smoking habits, 36 patients were no smokers (31.6%), 47 were former smokers (41.2%), and 31 were active smokers (27.2%). The Charlson Comorbidity Index (CCI) was ≥ 2 in 53 cases (46.5%), 1 in 35 cases (30.7%) and 0 in the remaining 26 (22.8%). In 48.2% of cases, the tumor was multifocal. Detrusor muscle was present in 97 (81,5%) samples of the first TURBt. Residual tumor was present in 40 (35.1%) patients. Pathological stage at re-TURBt was pTa in 7.9%, pT1 in 23.7% and pT2 in 3.5% of cases. In the remaining 40 patients with residual disease, the histologic stage of the lesion was pTa in 7.9%, pT1 in 23.7% and pT2 in 3.5% of cases. In 19.3% of patients, a high-grade tumor was found at re-TURBT. After multivariate binomial logistic regression analysis, we observed that age (OR 1.05; 95% CI 1.01–1.11; p = 0.02), previous history for bladder neoplasm (OR 3.14; 95% CI 1.10–11.10; p = 0.04), presence of preoperative anemia (OR 5. 4; 95% CI 1.36–9.65; p = 0.02), preoperative platelet count (OR 1.01; 95% CI 1.00–1.01; p = 0.02), preoperative high neutrophil-to-lymphocyte ratio (NLR) (OR1.23; 95% CI 1.01–1. 55; p = 0.05), training level of the surgeon (OR 0.09; 95% CI 0.01–0.42; p = 0.01), and tumor grading (OR 2.71; 95% CI 1.14–8.43; p = 0.04)were independently associated with outcome. The Area Under the Curve (AUC) of the model was 0.80. Conclusions: Increasing age, preoperative anemia, impaired neutrophil- to-lymphocyte ratio, and high-grade tumor at first TURBt were independent risk factors for residual tumor at re-TURBt. These initial Results may allow a more accurate selection of patients to be considered for re-TURBt. Further investigations are needed.