PURPOSE: There is lack of evidence regarding the indication for re-transurethral resection of bladder tumor (reTURBT) for Ta high grade (HG) non-muscle invasive bladder cancer (NMIBC). This study aims to evaluate the oncological outcomes of patients with TaHG NMIBC to determine the benefit from performing reTURBT. METHODS: We relied on a multicenter cohort of 317 TaHG NMIBC from 12 centers who underwent TURBT and a subsequent complete Bacillus Calmette-Guérin induction from 2009 to 2021. Kaplan Meier analyses estimated recurrence free survival (RFS) and progression free survival (PFS) according to reTURBT. Sub-analyses evaluated PFS in patients with multiple risk factors indicating necessity for reTURBT according to international guidelines (multifocality, size > 3 cm, recurrent cancer, carcinoma in situ, lymph vascular invasion, histological variant, incomplete and absence of muscle layer at index TURBT). Multivariable cox-regression analysis predicted recurrence and progression. RESULTS: Of the 317 patients, 123 (39%) underwent reTURBT, while 194 (61%) did not. Residual disease was detected in 46% of cases, with a 3.2% upstaging rate. Median follow-up was 30 months. The 3-year RFS was higher in patients who underwent reTURBT (79% vs. 58%, p < 0.001), but no significant difference was observed in PFS. ReTURBT reduced the risk of recurrence [multivariable hazard ratio: 0.45, 95% Confidence interval (CI) 0.29-0.71]. Among patients who did not undergo reTURBT, those with ≥ 2 risk factors had lower 3-year PFS (73% vs. 92%, p < 0.001) than those with 0-1 risk factor, whereas no difference in 3-year PFS was observed in patients who underwent reTURBT regardless of the number of risk factors (85% vs. 87%, p = 0.8). CONCLUSION: ReTURBT demonstrated efficacy in reducing recurrence among patients with TaHG NMIBC, yet its impact on progression remained uncertain. Our study underscores the importance of adhering to current international guidelines, particularly for patients with multiple risk factors indicating necessity for reTURBT.

Belegarzt für Urologie Luzerner Kantonsspital Lucerne Switzerland

Clinica Luganese Moncucco Lugano Switzerland

Department of Maternal Infant and Urologic Sciences Sapienza University Umberto 1 Polyclinic Hospital Rome Italy

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology and Oncologic Urology Wrocław Medical University Wroclaw Poland

Department of Urology Careggi Hospital University of Florence Florence Italy

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna General Hospital Vienna Austria

Department of Urology Luzerner Kantonsspital Lucerne Switzerland

Department of Urology Medical University of Innsbruck Innsbruck Austria

Department of Urology Netherlands Cancer Institute 1066 CX Amsterdam Netherlands

Department of Urology Puigvert Foundation Autonomous University of Barcelona Barcelona Spain

Department of Urology Spedali Civili Hospital University of Brescia Brescia Italy

Department of Urology University of Texas Southwestern Dallas TX USA

Department of Urology University of Tor Vergata Rome Italy

Department of Urology UROSUD La Croix Du Sud Hospital Quint Fonsegrives France

Department of Urology Weill Cornell Medical College New York NY USA

Division of Experimental Oncology Unit of Urology URI Urological Research Institute IRCCS Ospedale San Raffaele Scientific Institute Via Olgettina 60 20132 Milan Italy

Division of Urology Department of Surgical Sciences Torino School of Medicine Turin Italy

Karl Landsteiner Institute of Urology and Andrology Vienna Austria

Sant'Anna Clinic Swiss Medical Group Sorengo Switzerland

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