pTa High grade urothelial bladder cancer: Recurrence, progression pattern and role of second TURBT
To examine the role of a second TURBT in the pTa high grade group and to generate recurrence and progression data for this group.
We retrospectively studied the clinical profile and outcome of all patients diagnosed with pTa high grade lesion at first TURBT, between the years 2006-2015.
Of 153 histopathology reports, 112 were selected based on inclusion/exclusion criteria. Out of the study population of 112 patients, 43(38.3%) had a second TURBT. Indications for second TURBT were high grade lesion (n = 36), absence of detrusor muscle (n = 2), and incomplete resection (n = 5). 18.4% patients with complete first TURBT had positive findings on second TURBT (3 carcinoma in situ, 2 pTa low grade lesions and 2 pTa high grade lesions). There was no upstaging. Of 5 with incomplete first TURBT, one upstaged to pT1 on second TURBT. On follow up 25.9% recurred and 8.6% progressed. The estimated median recurrence free survival was 60 months (95% CI 29.2-90.7). Multiple (≥2) tumours had higher recurrence (HR of 4.60, CI 1.67-12.63, p = 0.003).
One fifth of patients with pTa high grade tumours had a positive finding on second TURBT. Second TURBT can act as quality control for the first resection and should be applied to the pTa high grade group till this group is better sub-classified. Multiple tumours are four times as likely to recur as solitary tumours and can be used as a prognostic marker in planning treatment and follow up for this subgroup.