Risk factors for residual disease at re-TUR in a large cohort of T1G3 patients

Translated title of the contribution: Risk factors for residual disease at re-TUR in a large cohort of T1G3 patients

F. Pisano*, P. Gontero, R. Sylvester, S. Joniau, V. Serretta, S. Larré, S. Di Stasi, B. van Rhijn, A. Witjes, A. Grotenhuis, R. Colombo, A. Briganti, M. Babjuk, V. Soukup, P. U. Malmstrom, J. Irani, N. Malats, J. Baniel, R. Mano, T. CaiE. Cha, P. Ardelt, J. Varkarakis, R. Bartoletti, G. Dalbagni, S. F. Shariat, E. Xylinas, R. J. Karnes, J. Palou

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Introduction and objectives: The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. It is well known that the presence of detrusor muscle in the specimen is a prerequisite to minimize the risk of under staging. Persistent disease after resection of bladder tumors is not uncommon and is the reason why the European Guidelines recommended a re-TUR for all T1 tumors. It was recently published that when there is muscle in the specimen, re-TUR does not influence progression or cancer specific survival. We present here the patient and tumor factors that may influence the presence of residual disease at re-TUR. Material and methods: In our retrospective cohort of 2451 primary T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. 74% had multifocal tumors, 20% of tumors were more than 3 cm in diameter and 26% had concomitant CIS. In this subgroup of patients who underwent re-TUR, there was no residual disease in 267 patients (29%) and residual disease in 667 patients (71%): Ta in 378 (40%) and T1 in 289 (31%) patients. Age, gender, tumor status (primary/recurrent), previous intravesical therapy, tumor size, tumor multi-focality, presence of concomitant CIS, and muscle in the specimen were analyzed in order to evaluate risk factors of residual disease at re-TUR, both in univariate analyses and multivariate logistic regressions. Results: The following were not risk factors for residual disease: age, gender, tumor status and previous intravesical chemotherapy. The following were univariate risk factors for presence of residual disease: no muscle in TUR, multiple tumors, tumors > 3 cm, and presence of concomitant CIS. Due to the correlation between tumor multi-focality and tumor size, the multivariate model retained either the number of tumors or the tumor diameter (but not both), p < 0.001. The presence of muscle in the specimen was no longer significant, while the presence of CIS only remained significant in the model with tumor size, p < 0.001. Conclusions: The most significant factors for a higher risk of residual disease at re-TUR in T1G3 patients are multifocal tumors and tumors more than 3 cm. Patients with concomitant CIS and those without muscle in the specimen also have a higher risk of residual disease.

Translated title of the contributionRisk factors for residual disease at re-TUR in a large cohort of T1G3 patients
Original languageEnglish
Pages (from-to)473-478
Number of pages6
JournalActas Urologicas Espanolas
Issue number6
StatePublished - 1 Jul 2021
Externally publishedYes


  • Non-muscle invasive bladder cancer
  • Progression
  • Re-transurethral resection of the bladder
  • Recurrence
  • Residual disease


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