AUTHOR=Contieri Roberto , Lughezzani Giovanni , Buffi Nicolò Maria , Taverna Gianluigi , Giacobbe Alessandro , Micheli Emanuele , Barra Sabato , Colombo Piergiuseppe , Vanni Elena , Guazzoni Giorgio , Lazzeri Massimo , Hurle Rodolfo ,  HuNIRe Study Group , Casale Paolo , Saita Alberto , Gobbo Andrea , Beatrici Edoardo , Avolio Pier Paolo , Uleri Alessandro , Paciotti Marco , Fasulo Vittorio , Frego Nicola , Maffei Davide , Diana Pietro , Zanoni Matteo , Domanico Luigi , Collura Devis , Elefante Maria Grazia , Cieri Miriam 

TITLE=Could We Safely Avoid a Second Resection in Selected Patients With T1 Non-Muscle-Invasive Bladder Cancer? Preliminary Results of Cost-Effectiveness Study From HUmanitas New Indications for ReTUR (HuNIRe) Multicenter Prospective Trial

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.879399

DOI=10.3389/fonc.2022.879399

ISSN=2234-943X

ABSTRACT=Objectives: The aim of this study is to assess whether ReTUR could be safely replaced with urine cytology (UC) and in-office flexible cystoscopy in selected T1 Non-muscle invasive bladder cancer.
Materials and Methods: This is an ongoing prospective multicenter trial enrolling patients diagnosed with T1 BC from 5 Italian centers. Patients with a macroscopically incomplete initial resection or absence of detrusor muscle were subjected ReTUR according to EAU Guidelines. Conversely, those with a complete tumor resection at initial TUR, underwent a UC at 3-4 week and in-office flexible white-light and narrow-banding cystoscopy at 4-6 week. In case of positive UC, or evidence of recurrence at cystoscopy, ReTUR was performed within 2 weeks. Otherwise, patients started BCG induction course without ReTUR. The primary endpoint was to determine the feasibility and the clinical utility of not performing ReTUR in selected T1 NMIBC patients. The secondary endpoint was to perform a cost-benefit analysis of this alternative approach.
Results: Since May 2020, among 87 patients presenting with T1, 76 patients were enrolled. Nineteen (25%) patients underwent standard ReTUR after initial resection, 9 (11.8 %) due to the absence of the detrusor muscle and 10 (13.2%) due to a macroscopically incomplete initial TUR. Overall, 57 (75%) patients initially avoided immediate ReTUR and underwent UC plus in-office flexible cystoscopy. Among them, 38 (66.7%) had no evidence of residual disease, and immediately started the BCG induction course. Nineteen patients (33.3%) underwent “salvage” ReTUR due to either positive UC (7; 12.3%) or suspicious cystoscopy (12; 21%). The saving of resource for each safely avoided ReTUR was estimated to be 1759 €. Considering the entire sample, we estimated a saving on the of 855 € per patient if compared with the EAU guidelines approach.
Conclusion:  The preliminary results of our trial suggested that ReTUR might be safely avoided in highly selected T1 BC patients with a complete resection at first TUR. Longer follow-up and larger sample size are needed to investigate the long-term oncological outcomes of this alternative approach.