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, Ana; Subiela, Jose Daniel; Artiles Medina, Alberto; Krajewski, Wojciech; Pichler, Renate; Van Creij, Nils C H; De La Estella Lucena, María De La Palma; De La Parra, Irene; Mínguez Ojeda, Cesar; Coloma, Almudena; Crespo Martínez, Luis; Del Olmo Durán, Pedro; González-Padilla, Daniel A; Villacampa, Felipe; Aumatell, Júlia; Scilipoti, Pietro; Longoni, Mattia; Moschini, Marco; De Angelis, Mario; Caño-Velasco, Jorge; Contieri, Roberto; Gallioli, Andrea; D'Andrea, David; Acosta, Eduardo Albers; Ajami, Tarek; Grobet-Jeandin, Elisabeth; Del Giudice, Francesco; Santarelli, Valerio; Ślusarczyk, Aleksander; Albisinni, Simone; Soria, Francesco; Mertens, Laura S; Tully, Karl; Mari, Andrea; Guerrero-Ramos, Félix; Alvarez-Maestro, Mario; Anagua Melendres, Franklin; Buisan, Oscar; Afferi, Luca; Gajate, Pablo; Guerrero, Patricia; Saiz, Ana; Pradere, Benjamin; Burgos Revilla, Francisco Javier. - 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.
