The Role of Early Re-Resection in pTaG3 Transitional Cell Carcinoma of the Urinary Bladder

Abstract

Aim: The clinical outcome and optimal treatment methodology for pTaG3 transitional cell carcinoma (TCC) of the urinary bladder remains controversial. We retrospectively evaluate the clinical behaviour and final outcome of 64 patients diagnosed with primary pTaG3 TCC bladder and evaluate the role of early re-resection following initial diagnosis. Patients and methods: Between January 2000 and December 2008, 64 patients were diagnosed with primary pTaG3 TCC of the urinary bladder at our institution. Following a careful retrospective review of their medical records, clinical parameters including patient age, gender, tumour morphology, operating surgeon's experience and adjuvant therapies were entered into a database. The outcome of re-resection, recurrence rate, progression and overall survival were recorded. All patients had their upper tracts screened with an ultrasound and intravenous urogram (IVU). Results: The mean age at time of diagnosis was 78 years (range 59–98). Seventy seven percent (49) of patients underwent an early re-resection (group 1). Residual tumour was identified in 49% (24) patients and the incidence of tumour upstaging was 10% (7). At re-resection 3% (2) of patients were found to have muscle-invasive disease. Twenty three percent (15) of patients did not have an early re-resection (group 2). There was a significant reduction in the incidence of recurrent TCC in group 1 in comparison to group 2 (5% vs. 62%) [ p < 0.05]. At a mean follow up of 48.9 months (range 12–124), 48 patients (75%) were alive; 25% (16) of patients had died of causes unrelated to bladder cancer. Disease-specific survival in both groups was 100%. Conclusion: pTaG3 TCC of the urinary bladder shows a variable clinical course and early re-resection significantly reduces the risk of recurrence. We strongly recommend treatment with early re-resection and subsequent treatment as per histology at re-resection. All patients with primary pTaG3 TCC of the urinary bladder should be followed up with further close surveillance using a strict follow up as these patients have a potential for disease progression.