Outcome in patients with exclusive carcinoma in situ (CIS) after radical cystectomy

Abstract

Objective• To evaluate oncological outcomes of patients with carcinoma in situ (CIS) exclusively at radical cystectomy (RC) and no previous history of ≥T1 disease. Patients and Methods• Patients undergoing RC with curative intent for CIS between 1971 and 2008 at the University of Southern California were included if they met all the following criteria: (i) pathological CIS-only disease at RC, (ii) preoperative clinical stage cCIS and/or cCIS + cTa, and (iii) no previous history of lamina propria invasion (≥pT1).• Kaplan-Meier plots were used to estimate the probabilities of recurrence-free survival (RFS) and overall survival (OS). Results• Of the 1964 consented patients 52 met the inclusion criteria with a median (range) follow-up of 8.5 (0.008-34) years.• A median (range) of 36 (10-95) lymph nodes were identified per patient but no metastases found.• Estimated 5-and 10-year RFS rates were 94% and 90%, respectively and estimated 5-and 10-year OS rates were 85% and 66%, respectively. • Different mechanisms of recurrence were found in four (8%) patients after a median (range) interval of 2.4 (0.6-7.1) years. While two patients had metachronous recurrence within the urinary tract, the first of the other two had early systemic recurrence and the second late local recurrence.

Molecular substratification of bladder cancer: moving towards individualized patient management

“…However, carcinoma in situ (CIS) is a flat lesion with a high propensity for invasion and metastasis. Patients with only CIS lesions in their urinary tract may also have synchronous with or without development of metachronous tumors [Zehnder et al 2014]. Ta tumors are suggested to develop due to molecular aberrations that are usually distinct from CIS and the invasive (T1–T4) cancers, although these pathways may not always be mutually exclusive (Figure 1) [Wu, 2005; Knowles, 2006].…”

Management of carcinoma in situ of the bladder: best practice and recent developments

“…Furthermore, outcomes for patients with pathologic CIS and T1 have been very favorable. The 10-year disease-free survival rates have been reported to be up to 90% [Bianco et al 2004; Hassan et al 2004; Shariat et al 2006; Zehnder et al 2014].…”

Risk factors associated with positive surgical margins’ location at radical cystectomy and their impact on bladder cancer survival

“…Such inclination might be partially elucidated by the unique features of CIS that, despite being part of the NMIBC category, can be characterized as MIBC at the molecular level by its high levels of genomic instability and mutations in TP53 [23]. Furthermore, a high concordance between history of CIS and its presence at RC specimen has described [24]. Although not the main focus of the current study, our results of the multifocal nature of CIS and the higher associated risk for ureteric PSM in case of concomitant CIS highlighted the role of intraoperative frozen section analysis (FSA) as a critical crossroad of margins' management.…”