Impact of Preoperative Diagnostic TURBT on Progression-Free Survival in Patients with Pathological High-Grade, Stage T3/T4 Bladder Urothelial Carcinoma

Transurethral bladder tumor resection (TURBT) reportedly increases the circulating tumor cell count in patients with urothelial carcinoma of the bladder (UCB). To determine whether diagnostic TURBT leads to poorer progression-free survival (PFS) than diagnostic cystoscopic biopsy, we retrospectively reviewed the records of 96 consecutive primary pathological high-grade, stage T3/T4 UCB patients treated with radical cystectomy (RC) between January 2009 to December 2013. Clinicopathological features were collected from the medical records. PFS was determined from Kaplan-Meier curves, and potential independent prognostic factors for PFS were identified based on multivariable Cox analysis. During the follow-up period (median, 29 months), 43 patients experienced tumor progression (40 received diagnostic TURBT, 56 received cystoscopic biopsy). Patients who received cystoscopic biopsy had better PFS than those who received diagnostic TURBT (p = 0.008). Additionally, diagnostic TURBT was a significant risk factor for tumor metastasis in both univariable (HR: 2.219; 95% CI: 1.207-4.079; p = 0.010) and multivariable (HR: 2.455; 95% CI: 1.278-4.714; p = 0.007) Cox analyses. The present study provides the first evidence that diagnostic TURBT before RC negatively affects PFS in patients with pathological high-grade, stage T3/T4 UCB.