Can restaging transurethral resection of T1 bladder cancer select patients for immediate cystectomy?

Purpose: We determined whether pathological findings on restaging transurethral resection predict early stage progression of T1 bladder cancer. Materials and Methods: A cohort of 352 patients presenting with T1 bladder cancer on initial transurethral resection was evaluated by second or restaging transurethral resection. All patients received bacillus Calmette-Guerin therapy and 88% were followed for 5 years. Pathological findings on restaging transurethral resection were correlated with tumor features, stage progression frequency and progression-free survival. Results: Of the 352 patients with T1 tumors 203 (58%) had residual tumor on restaging transurethral resection, including 92 (26%) with residual nonmuscle invasive (T1) cancer. During 5 years 66% of cases recurred and 35% progressed in stage. Of the 92 patients with residual T1 cancer 75 (82%) progressed to muscle invasion within 5 years compared to 49 of 260 (19%) who had no or nonT1 tumor detected on restaging transurethral resection. Conclusions: Restaging transurethral resection identifies patients with T1 bladder cancer who are at high risk for early tumor progression, justifying immediate cystectomy.