PURPOSE: The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis to adequately stage and treat the patient. Persistent disease after TUR is not uncommon and is why re-TUR is recommended in T1G3 patients. When there is T1 tumor in the re-TUR specimen, very high risks of progression (82%) have been reported. We analyze the risks of recurrence, progression to muscle-invasive disease and cancer-specific mortality (CSM) according to tumor stage at re-TUR in T1G3 patients treated with BCG. METHODS: In our retrospective cohort of 2451 T1G3 patients, 934 patients (38.1%) underwent re-TUR. 667 patients had residual disease (71.4%): Ta in 378 (40.5%), T1 in 289 (30.9%) patients. Times to recurrence, progression and CSM in the three groups were estimated using cumulative incidence functions and compared using the Cox regression model. RESULTS: During a median follow-up of 5.2 years, 512 patients recurred. The recurrence rate was significantly higher in patients with a T1 at re-TUR (P < 0.001). Progression rates differed according to the pathology at re-TUR, 25.3% in T1, 14.6% in Ta and 14.2% in case of no residual tumor (P < 0.001). Similar trends were seen in both patients with and without muscle in the original TUR specimen. CONCLUSIONS: Patients with T1G3 tumors and no residual disease or Ta at re-TUR have better recurrence, progression and CSM rates than previously reported, with a CSM rate of 13.1 and a 25.3% progression rate in re-TUR T1 disease.

Department of Biostatistics EORTC Headquarters Brussels Belgium

Department of Experimental and Clinical Medicine University of Florence Florence Italy

Department of Surgical Oncological and Stomatological Sciences University of Palermo Palermo Italy

Department of Surgical Science John Radcliffe Hospital University of Oxford Oxford UK

Department of Urology Academic Hospital Uppsala University Uppsala Sweden

Department of Urology Centre Hospitalier Universitaire La Milétrie University of Poitiers Poitiers France

Department of Urology Cochin Hospital Paris France

Department of Urology Fundacio Puigvert University of Barcelona Barcelona Spain

Department of Urology Mayo Clinic Rochester MN USA

Department of Urology Memorial Sloan Kettering Cancer Center New York NY USA

Department of Urology Motol Hospital University of Praha Prague Czech Republic

Department of Urology Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

Department of Urology Rabin Medical Centre Tel Aviv Israel

Department of Urology Radboud University Nijmegen Medical Centre Nijmegen The Netherlands

Department of Urology Santa Chiara Hospital Trento Italy

Department of Urology Sismanoglio Hospital University of Athens Athens Greece

Department of Urology Weill Medical College of Cornell University New York NY USA

Dept of Urology Ospedale Città della Salute e della Scienza Molinette Corso Bramante 88 10126 Turin Italy

Dipartimento di Urologia Università Vita Salute Ospedale S Raffaele Milan Italy

Facharzt fur Urologie Abteilung fur Urologie Chirurgische Universitats klinik Freiburg Germany

Genetic and Molecular Epidemiology Group Spanish National Cancer Research Centre Madrid Spain

Medical University of Vienna Vienna Austria

Oncologic and Reconstructive Urology Department of Urology University Hospitals Leuven Louvain Belgium

Policlinico Tor Vergata University of Rome Rome Italy

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