Re-TURBT before cystectomy has similar pathologic upgrade rates regardless of NAC status

Transurethral resection of tumor bladder resection (TURBT) before radical cystectomy (CR) with or without neoadjuvant chemotherapy (NAC) is associated with similar rates of pathological downgrading, the researchers reported at the 2021 annual meeting of the Society of Urological Oncology.¹

For the study, presented by first author Justin Mehr, BS, of Baylor College of Medicine Dan L Duncan Comprehensive Cancer Center in Houston, Texas, researchers compared the precision of staging between the clinical re-TURBT stage and pathologic stage in patients who underwent re-TURBT post-NAC before CR vs. those who underwent re-TURBT before CR but did not receive NAC.

Investigators used an institutional database for the study, maintained prospectively and approved by a review committee, and identified 129 patients who underwent CR between 2013 and 2019 with re-TURBT prior to CR. Of these patients, 53 received NAC between their initial TURBT and their re-TURBT and 76 patients did not receive NAC.

The median age of CR patients was 69.5 years. Most of the patients (107, 82.9%) were male and 121 (93.8%) were Caucasian.

Investigators found that the overall upgrade rate from re-TURBT to RC was 34.9%, with 31.0% upgrading in the NAC group and 37.0% in the group without NAC (P = 0.584).

When looking at patients who had no residual disease (cT0, n = 21), “We found that there was no difference in the rate of disease-stage tumor absence, with 38.5% for the NAC group and 37.5% for the group without NAC. [P = 1.0]”said Mehr.

Researchers also examined re-TURBT with a lower staging than rT2 as a predictor of the absence of muscle invasive bladder cancer during pathological staging. They found that there was no significant difference between the groups, with negative predictive values ​​of 69.0% and 66.7% for the NAC and no NAC groups, respectively (P = .083).

Mehr reported that all patients with baseline TURBT positive lymph nodes were at pathologic stage T2 or higher after chemotherapy and re-TURBT (n = 7), and that of patients who were at clinical stage T1 post-NAC TURBT , 62.5% were pT2. or more.

Mehr also noted, “With a high rate of patients who were clinical stage T1 on a post-NAC re-TURBT having pathologically muscle invasive bladder cancer, these patients will be eligible for adjuvant immunotherapy with. nivolumab [Opdivo] and clinical trials testing alternative adjuvant treatment regimens.

“Although we have consistently found that one of the best predictors of positive clinical outcome and survival is pT0 after CR, challenges remain regarding the accuracy of clinical staging with TURBT restaging and [exam under anesthesia]. Clinical trials that test for bladder preservation in these patients require careful monitoring to determine results relating to the potential for residual bladder cancer and occult disease, â€Mehr said in his concluding remarks.

Reference

1. Mehr J, Bates JN, Lerner SP. Benefits of transurethral resection of a bladder tumor before radical cystectomy with or without neoadjuvant chemotherapy. Paper presented at the 2021 Annual Meeting of the Society of Urologic Oncology; December 1-3, Orlando, Florida. Summary 79. https://suo-abstracts.secure-platform.com/a/gallery/rounds/12/details/1530