Who is at Risk of Residual Tumor and Pathologic Upstaging at a Second TURBT in Non-Muscle-Invasive Bladder Cancer?

This study aimed to determine the rates and predictors of residual tumor and pathologic upstaging among patients undergoing a second transurethral resection of bladder tumors (TURBT).

This retrospective study investigated patients who underwent a second TURBT within 2-6 weeks after an initial complete TURBT for non-muscle-invasive bladder cancer. A second TURBT was performed in cases of T1 tumors, high-grade Ta tumors, and absence of the detrusor muscle in the initial specimen. Patients were initially categorized by the presence of residual tumor, and those with residual disease were further stratified according to their pathologic upstaging status. Potential predictors, including patient demographics, tumor characteristics, surgical team consistency, and complications, were analyzed using logistic regression.

Among 728 patients who underwent TURBT, 284 met the inclusion criteria and were included in the analysis. Residual tumor was detected in 144 patients (50.7%). Multivariable analysis showed that multifocality, tumor size ≥ 3 cm, resection from both the primary and additional sites, complications, and female sex were independently associated with residual tumor (all p < 0.05). Pathologic upstaging was observed in 20 (13.9%) of the 144 patients with residual tumor. Primary tumor morphology was the only independent predictor of pathologic upstaging, with solid (odds ratio [OR], 7.72; p = 0.013) and papillosolid (OR, 4.07; p = 0.020) morphologies associated with a higher risk than papillary morphology.

A second TURBT remains an important reassessment step for residual tumor and upstaging. Risk assessment for patients undergoing a second TURBT should incorporate initial pathology, tumor burden, endoscopic appearance, and tumor morphology.