Postresection Urinary Tumor DNA Refines Residual Disease Assessment and Recurrence Risk Stratification in Non-Muscle-Invasive Bladder Cancer
In brief
Urinary tumor DNA sharpens residual tumor detection and recurrence risk estimates
Among 161 patients undergoing repeat bladder tumor resection, 35% had residual tumor. Adding a urine tumor DNA test substantially improved identification of residual disease and improved recurrence risk estimates beyond established clinical tools; a negative result also flagged many patients selected for repeat surgery as lower-yield, though about 1 in 10 still had tumor. Whether test-guided surgery or surveillance improves outcomes remains untested.
- Journal
- JCO precision oncology (Q1)
- Published
- 4 November 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Shiwang Huang, Zihan Xue, Ning Kang, Boyue Ma, Kaipeng Jia, Yuda Lin, et al.
- PMID
- 42981539
- DOI
- 10.1200/PO-26-00676
Why clinicians should know about it
- Picked for Urology (paper of the day, 7 November 2026): Assesses urinary tumor DNA for repeat TURBT and recurrence risk
Abstract
PURPOSE: Repeat transurethral resection of bladder tumor (TURBT) is recommended for selected patients with non-muscle-invasive bladder cancer (NMIBC), but clinicopathologic indications are broad and often identify no residual tumor. We tested whether postresection urinary tumor DNA (utDNA) adds value beyond guideline-derived repeat-TURBT selection and established recurrence risk models. MATERIALS AND METHODS: This guideline-anchored cohort analysis included 161 patients with NMIBC who underwent repeat TURBT. Urine was collected 2 to 6 weeks after initial TURBT and before repeat TURBT. Tissue-naïve utDNA and cytology were compared with repeat-TURBT pathology and evaluated against repeat-TURBT indication sets, European Association of Urology (EAU) risk grouping, The European Organisation for Research and Treatment of Cancer (EORTC) models, and Club Urologico Espanol de Tratamiento Oncologico (CUETO) models. RESULTS: Residual tumor was found in 57 patients (35.4%). Core, expanded, and carcinoma in situ-augmented core indication sets selected 73.3%, 88.2%, and 80.7% of patients. Within these indication-positive groups, utDNA-negative status identified 66.9% to 67.7% as lower-yield, although 9.1% to 10.4% still had residual tumor. Adding utDNA increased residual tumor AUCs from 0.544 to 0.891, 0.537 to 0.892, and 0.513 to 0.890 for the three indication sets, respectively. For any recurrence, c-indices increased from 0.602 to 0.774 for EAU risk grouping, 0.717 to 0.837 for EORTC models, and 0.770 to 0.824 for CUETO models after adding utDNA. CONCLUSION: Postresection utDNA refined residual tumor detection beyond repeat-TURBT indication sets and improved recurrence risk stratification beyond EAU/EORTC models, with directionally consistent CUETO results. Positive utDNA after negative repeat TURBT suggested occult molecular risk and supports prospective testing of utDNA-informed resection and surveillance algorithms.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.