Objective

NICE bladder cancer guidelines currently recommend that patients with a pathological grading of G2ta bladder Transitional Cell Carcinoma (TCC) at first diagnosis Trans-Urethral Resection of Bladder Tumour (TURBT) without muscle in the specimen, should undergo a restaging TURBT within 6 weeks. We investigated our population of G2ta bladder TCC patients, to compare outcomes in patients with and without detrusor muscle in the initial specimen. The study aimed to ascertain whether a restaging TURBT was necessary in this group. 

Methods

Patients with a diagnosis of G2ta bladder TCC were identified from a bladder cancer database (diagnosed 2012 -2019). Retrospective data was collected from the Somerset Cancer Registry.

Results

A total of 143 patients were identified for inclusion, based on a first diagnosis of G2ta bladder TCC from 2012 – 2019. N=98 (69%) patients had muscle in their first specimen, n=45 (31%) patients did not have muscle in the initial diagnostic specimen. Of these patients with no muscle in their specimen, an MDT decision was made to perform a restaging TURBT in 13 patients (29%). Of these 13 patients, only one patient was upgraded to G3T1 TCC.
Of the 45 patients who did not have muscle present in their initial specimen, the recurrence rate at 1 year was 35% (n=16). In the 98 patients who had muscle present in their initial specimen, the recurrence rate at 1 year was 31% (n=31). No significant difference was detected between the recurrence rates in each group (p=0.7, Fisher’s exact test). The number of patients upgraded within the year was 8% (n=4/45) and 6% (n=6/98), in the groups with no muscle present and muscle present, respectively. No significant difference was detected in high-grade recurrence between the groups (p=0.7, Fisher’s exact test).

Conclusion

Our data shows that there is no difference in the recurrence or upgrade rate at 1 year in patients with initial G2ta bladder TCC, whether muscle is present in the specimen or not. This suggests that it is unnecessary to perform a restaging TURBT at 6 weeks in these patients, even if there is no detrusor muscle present in the initial resection specimen.

G2ta bladder cancer without detrusor, do we need to restage at 6 weeks?