Does grossly complete transurethral resection improve response to neoadjuvant chemotherapy?

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Controversy exists regarding the benefit of a complete transurethral resection of bladder tumor (TURBT) for muscle-invasive bladder cancer (MIBC) prior to neoadjuvant chemotherapy (NAC).
• Some advocate for complete TURBT, suggesting it increases NAC response rates, while others argue it poses surgical risks without clear advantages.

Purpose of the Study:

• To investigate the association between the completeness of TURBT and the response to cisplatin-based NAC in patients with MIBC.
• To identify factors influencing complete response (ypT0) or absence of residual muscle-invasive disease (ypT < 2) after NAC.

Main Methods:

• Retrospective review of a radical cystectomy (RC) database (2011-2018) for patients with nonmetastatic MIBC who received NAC.
• Univariable and multivariable logistic regression analyses were used to assess the impact of TURBT completeness and other clinicopathologic factors on NAC response.

Main Results:

• Of 100 analyzed patients, 49 had complete TURBT and 51 had incomplete TURBT prior to NAC, with no significant baseline differences.
• The overall rates of ypT0 and ypT < 2 following NAC were 24% and 45%, respectively.
• No association was found between TURBT completeness and ypT0 or ypT < 2. Smoking status was negatively associated with ypT0 (OR=0.36, P=0.031).

Conclusions:

• The completeness of TURBT was not associated with response to cisplatin-based NAC in MIBC patients.
• The study's retrospective nature and inability to predict NAC response from TURBT tissue are limitations.