The Oncological Impact of Complete Transurethral Resection Before Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer

Abstract

Introduction Complete transurethral resection of bladder tumour has a clear role in non-muscle invasive bladder cancer neoplasm. However, there is a lack of evidence as to whether a complete resection is essential before neoadjuvant chemotherapy (NAC) in muscle invasive bladder cancer (MIBC). Material and methods Tertiary centre data from patients with MIBC submitted to NAC and radical cystectomy between March 2010 and November 2022 was retrospectively analysed. Patients with a complete resection (cTURBT) before NAC were compared to those with incomplete (iTURBT). The primary objective was to assess the impact of cTURBT on pathologic response. Survival and oncologic outcomes were also analysed. Results Thirty-seven patients were included in this study. NAC regime was identical between groups. cTURBT group demonstrated a higher rate of downstaging (11 cases, 50%) compared to the iTURBT group (2 cases, 13.3%, p = 0.022). During the mean 49 month of follow-up period, overall survival (86.4% vs. 40%, p=0.005), recurrence-free survival (81.8% vs. 46.7%, p=0.036) and cancer-specific survival (90.9% vs 60%, p=0.042) were higher in the cTURBT group. Furthermore, we observed significantly fewer relapses, higher survival rates, and lower oncological-related deaths in patients who exhibited downstaging. Conclusion Complete transurethral resection of bladder tumour demonstrated a favourable impact on patients with MIBC undergoing NAC, as it enhances pathologic downstaging and improves survival outcomes.