University of Hertfordshire

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  • Peter S. Kirk
  • Yair Lotan
  • Homayoun Zargar
  • Kamran Zargar
  • Adrian S Fairey
  • Colin P Dinney
  • Maria C Mir
  • Laura-Maria Krabbe
  • Michael S Cookson
  • Niels-Erik Jacobson
  • Jeffrey S Montgomery
  • Evan Y Yu
  • Evanguelos Xylinas
  • Wassim Kassouf
  • Marc A Dall'Era
  • Srikala S. Sridhar
  • Jonathan S McGrath
  • Jonathan Aning
  • Shahrokh F Shariat
  • Andrew C. Thorpe
  • Todd M Morgan
  • Jeff M Holzbeierlein
  • Trinity J Bivalacqua
  • Scott North
  • Daniel A Barocas
  • Petros Grivas
  • Jorge A Garcia
  • Andrew J Stephenson
  • Jay B Shah
  • Siamek Daneshmand
  • Philippe E Spiess
  • Bas WG van Rhijn
  • Peter C. Black
  • Jonathan L. Wright
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Original languageEnglish
JournalJournal of Urology
Publication statusSubmitted - 26 May 2022


While the presence of residual disease at the time of radical cystectomy (RC) for bladder cancer is an established prognostic indicator, controversy remains regarding the importance of maximal transurethral resection (TUR) prior to neoadjuvant chemotherapy (NAC). We sought to characterize the influence of maximal TUR on subsequent pathologic and survival outcomes using a large, multi-institutional cohort.
We identified 785 patients from a multi-institutional cohort undergoing RC for muscle invasive bladder cancer (MIBC) after NAC with data on extent of TUR. We employed bivariate comparisons and stratified multivariable models to quantify the effect of maximal TUR on pathologic findings at cystectomy and survival.
Of 785 patients, 579 (74%) underwent maximal TUR. Incomplete TUR was more frequent in patients with more advanced clinical tumor (cT) and nodal (cN) stage (p<0.001 and p<0.01, respectively), with more advanced ypT stage at cystectomy and higher rates of positive surgical margins (p<0.01 and p<0.05, respectively). In multivariable models stratified by cT stage, maximal TUR was associated with complete response (ypT0N0) in patients with more advanced (cT3/4) disease (adjusted odds ratio (aOR) 2.70, 95% confidence interval (CI) 1.09-6.69), as well as with pathologic downstaging (aOR 2.14, 95% CI 1.01-4.52). In Cox proportional hazards analysis maximal TUR was not associated with overall survival (adjusted hazard ratio 0.8, 95% CI 0.6-1.1).

In patients undergoing TUR for MIBC prior to neoadjuvant chemotherapy, maximal resection may improve pathologic response at cystectomy specifically in patients with more advanced cT stage. However, the ultimate effects on long term survival and oncologic outcomes warrant further investigation.

ID: 27479698