Does the Extent of Transurethral Resection after Radiation Therapy Impact Survival Outcomes in Muscle-Invasive Bladder Cancer - Expert Commentary

A current standard of care treatment for muscle-invasive bladder cancer (MIBC) is platinum-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). Bladder-sparing protocols are available for patients who cannot or prefer not to receive surgery and include maximal transurethral resection of the bladder (TURBT). Avolio et al. evaluated the effect of maximal TURBT after radiation therapy on response and survival outcomes in patients with MIBC.

The retrospective study cohort included 757 patients. Inverse probability of treatment weighting (IPTW) was used to reduce the confounding bias of baseline variables. The IPTW-adjusted cohort included 642 patients, of whom 51% had undergone complete TURBT. Complete response (CR) occurred in 64% of patients in the IPTW-adjusted cohort. Multivariable analysis indicated that cT3-4a stage (aOR, 0.43; 95% CI, 0.27 – 0.69; p < 0.001) and the presence of hydronephrosis (aOR, 0.48; 95% CI, 0.31 – 0.74; p = 0.001) were significantly associated with lower CR rate. The median follow-up time was 27 months and there were no significant differences in survival outcomes between patients who underwent complete versus incomplete TURBT (p > 0.5).

Interestingly, transurethral resection of bladder tumor (TURBT) was associated with a higher rate of organ-confined disease but did not significantly impact CR or survival outcomes compared to incomplete TURBT. Accordingly, the extent of TURBT may represent disease stage rather than influence the outcome.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

References:

  1. Avolio PP, Kool R, Shayegan B, et al. Effect of complete transurethral resection on oncologic outcomes after radiation therapy for muscle-invasive bladder cancer. Int J Radiat Oncol Biol Phys. 2024. doi:10.1016/j.ijrobp.2024.08.036
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