RESECT Study Results and Variations in NMIBC Recurrence Between Sites

The ongoing RESECT study began in 2021 to determine if audit and feedback could improve the quality of transurethral resection of bladder tumor (TURBT) in the treatment of non-muscle invasive bladder cancer (NMIBC) to see if it may lead to reduced disease recurrence.

A new observational study sought to determine if there is significant variation in early recurrence after TURBT between the sites taking part in the RESECT study. The results will be presented at the American Society of Clinical Oncology 2023 Annual Meeting.

RESECT took place across 186 sites (United Kingdom: 80; Europe: 59; North America: 18; Asia: 17; Africa 7; South America: 3; Oceania: 2). Sites were excluded if they did not have at least 10 cases with first check follow-up. A total of 4597 cases were included in the international, multicenter, observational study. The cases included had first, presumed NMIBC undergoing TURBT. Local and/or national approvals or ethical exemptions were obtained prior to commencing the study at participating sites.

The median recurrence rate per site was 12% for low-grade tumors and 27% for high-grade tumors. After controlling for tumor size, number, stage, and grade (all significantly and independently associated with early recurrence), there was significant residual variation attributable to the sites (P<.0001; intraclass correlation, 0.1).

Adjustment for sites improved the regression model from an area under the receiver operating characteristic curve of 0.66 to 0.74. Initial analysis of surgical and perioperative practice showed wide variation. A mean of 75% of cases per site had detrusor muscle resection and 42% (interquartile range, 17-58) had use of single instillation of intravesical chemotherapy. Other differences in operative and perioperative practice were identified through surveys.

Significant variation was noted in the early recurrence rate of NMIBC after TURBT between sites. The researchers have identified factors such as differences in surgical technique and perioperative practice that may have contributed to this variation. Further research is needed to understand how these factors may impact recurrence rates of NMIBC.