MP03-02: Association Between Visibly Complete Transurethral Resection of Bladder Tumor and Pathologic Downstaging Following Neoadjuvant Chemotherapy and Radical Cystectomy for Muscle-Invasive Bladder Cancer

Bryce Baird*, Jacksonville, FL, Augustus Anderson, New Orleans, LA, Christian Ericson, Gianpiero Carames, Paul Young, Timothy Lyon, Jacksonville, FL

Introduction: Neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is the standard of care in patients with muscle-invasive bladder cancer. However, there are conflicting data regarding the potential oncologic benefit of a visibly complete transurethral resection of bladder tumor (TURBT) prior to NAC and RC. Furthermore, the improved local staging offered by bladder MRI has called into question the value of a complete TURBT prior to NAC for patients with imaging evidence of muscle-invasive tumors.  The primary aim of this study was to evaluate if a visibly complete TURBT is associated with pathologic outcomes after NAC and RC.

Methods: We retrospectively reviewed our institutional RC database from 2011 to 2021 to identify patients who received NAC and RC for muscle-invasive bladder cancer. Records were independently reviewed to assess the completeness of TURBT. Six patients with missing TURBT data were classified as having an incomplete resection. The primary outcome was pathologic downstaging on RC specimen, defined as
Results: A total of 158 patients were identified, including 93 (59%) with a visibly complete TURBT. There were no significant differences in baseline characteristics between patients receiving complete versus incomplete TURBT. There was no significant difference in the rate of pathological downstaging for those with and without a visibly complete TURBT, 42% (39/93) vs 37% (24/65), p=0.63.  Likewise, there was no significant difference in the rate of complete pathologic response at RC between those with and without a visibly complete TURBT, 30% (28/93) vs 28% (18/65), P=0.79. After adjusting for age, gender, preoperative hydronephrosis, ECOG status, chemotherapy regimen and time from last chemotherapy to RC, there was no significant association between visibly complete TURBT and pathologic downstaging (adjusted OR 0.82, 95% CI 0.39-1.72, p=0.60).

Conclusions: A visibly complete TURBT was not associated with pathologic response following NAC and RC. This data does not support the need for a repeat TURBT to achieve a visibly complete resection of a muscle-invasive tumor if NAC and RC are planned. We await data from the ongoing randomized phase II/III BladderPath study to shed further light on this issue.

Source of Funding: None