Effect of Complete Transurethral Resection on Oncologic Outcomes After Radiation Therapy for Muscle-Invasive Bladder Cancer

Pier Paolo Avolio; Ronald Kool; Bobby Shayegan; Gautier Marcq; Peter C Black; Rodney H Breau; Michael Kim; Ionut Busca; Hamidreza Abdi; Mark Dawidek; Michael Uy; Gagan Fervaha; Fabio L Cury; Rafael Sanchez-Salas; Nimira Alimohamed; Jonathan Izawa; Claudio Jeldres; Ricardo Rendon; Robert Siemens; Girish S Kulkarni; Wassim Kassouf

doi:10.1016/j.ijrobp.2024.08.036

Effect of Complete Transurethral Resection on Oncologic Outcomes After Radiation Therapy for Muscle-Invasive Bladder Cancer

Int J Radiat Oncol Biol Phys. 2024 Aug 24:S0360-3016(24)03292-9. doi: 10.1016/j.ijrobp.2024.08.036. Online ahead of print.

Authors

Pier Paolo Avolio¹, Ronald Kool², Bobby Shayegan³, Gautier Marcq⁴, Peter C Black⁵, Rodney H Breau⁶, Michael Kim⁷, Ionut Busca⁶, Hamidreza Abdi⁶, Mark Dawidek⁵, Michael Uy³, Gagan Fervaha⁸, Fabio L Cury⁹, Rafael Sanchez-Salas¹⁰, Nimira Alimohamed¹¹, Jonathan Izawa¹², Claudio Jeldres¹³, Ricardo Rendon¹⁴, Robert Siemens⁸, Girish S Kulkarni⁷, Wassim Kassouf¹⁵

Affiliations

¹ Department of Urology, McGill University Health Centre, Montreal, QC, Canada; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
² Department of Urology, McGill University Health Centre, Montreal, QC, Canada; Department of Abdominal Surgery, Division of Urologic Oncology, Erasto Gaertner - Cancer Center, Curitiba, Brazil.
³ Division of Urology, McMaster University, Hamilton, ON, Canada.
⁴ Department of Urology, McGill University Health Centre, Montreal, QC, Canada; Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France.
⁵ Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
⁶ The Ottawa Hospital Research Institute, Division of Urology, University of Ottawa, Ottawa, ON, Canada.
⁷ Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
⁸ Department of Urology, Queen's University, Kingston, ON, Canada.
⁹ Department of Urology, McGill University Health Centre, Montreal, QC, Canada; Department of Radiation Oncology, McGill University Health Center, Montreal, QC, Canada.
¹⁰ Department of Urology, McGill University Health Centre, Montreal, QC, Canada.
¹¹ Division of Medical Oncology, University of Calgary, Calgary, AB, Canada.
¹² Division of Urology, Western University, London, ON, Canada.
¹³ Division of Urology, University of Sherbrooke, Sherbrooke, QC, Canada.
¹⁴ Division of Urology, Dalhousie University, Halifax, NS, Canada.
¹⁵ Department of Urology, McGill University Health Centre, Montreal, QC, Canada. Electronic address: [email protected].

PMID: 39186955
DOI: 10.1016/j.ijrobp.2024.08.036

Abstract

Purpose: To compare the oncologic outcomes of patients with nonmetastatic muscle-invasive bladder cancer (MIBC) undergoing complete versus incomplete transurethral tumor resection (TURBT) before radiation therapy.

Methods and materials: Patients with nonmetastatic MIBC who underwent curative-intent radiation therapy between 2002 and 2018 at 10 Canadian institutions were retrospectively evaluated. Inverse probability of treatment weighting was performed using baseline characteristics. Differences in survival outcomes by complete and incomplete TURBT were analyzed.

Results: Of the 757 patients included, 66% (498) had documentation of a complete and 34% (259) an incomplete TURBT. Before adjustment, 121 (47%) and 45 (9%) patients who underwent incomplete and complete TURBT, respectively, were diagnosed with cT3-4 tumor (P <.001). After weight-adjustment, all baseline cohort characteristics were balanced (absolute standardized differences < 0.1). The adjusted median follow-up was 27 months. Adjusted survival analyses showed no significant difference in 5-year overall survival (48% vs 52%, 1.03 [0.82-1.29]; P = .8), cancer-specific survival (64% vs 61%, 0.93 [0.70-1.25]; P = .7), metastasis-free survival (43% vs 46%, 0.97 [0.79-1.19]; P = .8), and disease-free survival (32% vs 35%, 0.95 [0.79-1.15]; P = .7) between the 2 groups.

Conclusions: Complete TURBT may be associated with clinical organ-confined disease. Extent of TURBT was not independently associated with oncologic outcomes in patients with MIBC treated with radiation therapy.