Objective: To evaluate the prognostic impact of T-stage at re-transurethral resection of bladder (TURB) and its utility for refining risk stratification across European Association of Urology 2021 (EAU21) risk groups in patients with T1 high-grade (HG) non-muscle-invasive bladder cancer (NMIBC) treated with adequate Bacillus Calmette–Guérin (BCG). Patients and Methods: Retrospective multicentre study including patients with primary or secondary T1HG NMIBC treated with TURB, re-TURB, and adequate BCG between 2007 and 2020 across 28 European academic centres. Patients were stratified according to re-TURB pathological stage (T0, Ta, Tis, T1) and EAU21 risk groups. Kaplan–Meier, Cox regression, and competing-risk methods were used to evaluate recurrence-free survival (RFS), HG-RFS, progression-free survival (PFS), and cancer-specific mortality (CSM). A mixture cure model estimated statistical cure fractions for the overall cohort. Results: Among 1403 patients, residual disease at re-TURB was identified in 38.8%, including 17.7% with persistent T1. Residual T1 was consistently associated with worse outcomes. Compared with T0/Ta, persistent T1 at re-TURB showed substantially lower 5-year HG-RFS and PFS, with high-grade recurrence in over half of patients and 5-year progression up to 48% in high- and very high-risk groups. The 5-year CSM rose from 6–7% (T0/Ta) to 23% (T1). On multivariable analysis, residual T1 was independently associated with worse HG-RFS (hazard ratio 2.40), PFS (hazard ratio 3.10), and CSM (hazard ratio 3.00). Cure modelling showed lower cure fractions for residual T1 compared with T0/Ta. Conclusion: Residual T1 at re-TURB is strongly associated with adverse long-term oncological outcomes in BCG-treated T1HG NMIBC and markedly reduces the likelihood of statistical cure. High- and very high-risk patients with persistent T1 represent a biologically adverse subgroup in whom standard BCG may be insufficient.
Impact of re-transurethral resection of bladder staging on risk stratification of high-grade T1 non-muscle-invasive bladder cancer across European Association of Urology 2021 risk groups / Fernández-Mardomingo, A., Subiela, J.D., Artiles Medina, A., Krajewski, W., Pichler, R., Van Creij, N.C.H., De La Estella Lucena, M.D.L.P., De La Parra, I., Mínguez Ojeda, C., Coloma, A., Crespo Martínez, L., Del Olmo Durán, P., González-Padilla, D.A., Villacampa, F., Aumatell, J., Scilipoti, P., Longoni, M., Moschini, M., De Angelis, M., Caño-Velasco, J., et al.. - In: BJU INTERNATIONAL. - ISSN 1464-410X. - 137:5(2026), pp. 866-876. [10.1111/bju.70207]
Impact of re-transurethral resection of bladder staging on risk stratification of high-grade T1 non-muscle-invasive bladder cancer across European Association of Urology 2021 risk groups
D'Andrea, David;Del Giudice, Francesco;Santarelli, Valerio;Albisinni, Simone;Mari, Andrea;
2026
Abstract
Objective: To evaluate the prognostic impact of T-stage at re-transurethral resection of bladder (TURB) and its utility for refining risk stratification across European Association of Urology 2021 (EAU21) risk groups in patients with T1 high-grade (HG) non-muscle-invasive bladder cancer (NMIBC) treated with adequate Bacillus Calmette–Guérin (BCG). Patients and Methods: Retrospective multicentre study including patients with primary or secondary T1HG NMIBC treated with TURB, re-TURB, and adequate BCG between 2007 and 2020 across 28 European academic centres. Patients were stratified according to re-TURB pathological stage (T0, Ta, Tis, T1) and EAU21 risk groups. Kaplan–Meier, Cox regression, and competing-risk methods were used to evaluate recurrence-free survival (RFS), HG-RFS, progression-free survival (PFS), and cancer-specific mortality (CSM). A mixture cure model estimated statistical cure fractions for the overall cohort. Results: Among 1403 patients, residual disease at re-TURB was identified in 38.8%, including 17.7% with persistent T1. Residual T1 was consistently associated with worse outcomes. Compared with T0/Ta, persistent T1 at re-TURB showed substantially lower 5-year HG-RFS and PFS, with high-grade recurrence in over half of patients and 5-year progression up to 48% in high- and very high-risk groups. The 5-year CSM rose from 6–7% (T0/Ta) to 23% (T1). On multivariable analysis, residual T1 was independently associated with worse HG-RFS (hazard ratio 2.40), PFS (hazard ratio 3.10), and CSM (hazard ratio 3.00). Cure modelling showed lower cure fractions for residual T1 compared with T0/Ta. Conclusion: Residual T1 at re-TURB is strongly associated with adverse long-term oncological outcomes in BCG-treated T1HG NMIBC and markedly reduces the likelihood of statistical cure. High- and very high-risk patients with persistent T1 represent a biologically adverse subgroup in whom standard BCG may be insufficient.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
