Characteristics and Outcomes of Patients With Clinical Carcinoma In Situ Only Treated With Radical Cystectomy

An International Study of 243 Patients

Derya Tilki, Oliver Reich, Robert S. Svatek, Pierre I. Karakiewicz, Wassim Kassouf, Giacomo Novara, Vincenzo Ficarra, Daher C. Chade, Hans Martin Fritsche, Niklas Gerwens, Jonathan I. Izawa, Seth P. Lerner, Mark Schoenberg, Christian G. Stief, Eila Skinner, Yair Lotan, Arthur I Sagalowsky, Shahrokh F. Shariat

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Purpose: We describe the rate of up staging and the cancer specific outcomes of patients with carcinoma in situ refractory to transurethral resection with intravesical therapy treated with radical cystectomy. Materials and Methods: The records of 3,207 patients treated with radical cystectomy for urothelial carcinoma of the bladder at 8 centers in the United States, Canada and Europe were reviewed. Results: Of the 3,207 patients who underwent radical cystectomy 243 (7.6%) had clinical carcinoma in situ only disease before radical cystectomy. At radical cystectomy 117 patients (48.1%) had carcinoma in situ only, 20 (8.2%) had pT0 urothelial carcinoma of the bladder, 19 (7.8%) had pTa urothelial carcinoma of the bladder and 36% had disease up staged (32 [13.2%] pT1, 29 [11.9%] pT2, 12 [4.9%] pT3 and 14 [5.8%] pT4). A total of 22 patients (9.1%) had lymphovascular invasion in the radical cystectomy specimen and 14 (5.8%) had metastasis to regional lymph nodes. Overall 5-year recurrence-free and cancer specific survival estimates were 74% (95% CI 68-79) and 85% (95% CI 80-89), respectively. On multivariable analysis adjusting for the effects of standard predictors, lymph node metastasis and lymphovascular invasion were associated with an increased risk of disease recurrence (p = 0.017 and p = 0.043, respectively) and cancer specific mortality (p = 0.019 and p = 0.001, respectively). Female gender was an independent risk factor for cancer specific mortality (p = 0.029) but not for disease recurrence (p = 0.173). Conclusions: Approximately a fourth of patients treated with radical cystectomy for clinical carcinoma in situ only had muscle invasive disease and 5.8% had metastasis to regional lymph nodes. Identification of those patients with a potentially aggressive natural history of carcinoma in situ is of the utmost importance as they are likely to benefit from early radical cystectomy.

Original languageEnglish (US)
Pages (from-to)1757-1763
Number of pages7
JournalJournal of Urology
Volume183
Issue number5
DOIs
StatePublished - May 2010

Fingerprint

Cystectomy
Carcinoma in Situ
Urinary Bladder
Lymph Nodes
Neoplasm Metastasis
Carcinoma
Recurrence
Neoplasms
Mortality
Neoplasm Staging
Canada
Muscles
Survival

Keywords

  • carcinoma
  • carcinoma in situ
  • prognosis
  • survival
  • transitional cell
  • urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Characteristics and Outcomes of Patients With Clinical Carcinoma In Situ Only Treated With Radical Cystectomy : An International Study of 243 Patients. / Tilki, Derya; Reich, Oliver; Svatek, Robert S.; Karakiewicz, Pierre I.; Kassouf, Wassim; Novara, Giacomo; Ficarra, Vincenzo; Chade, Daher C.; Fritsche, Hans Martin; Gerwens, Niklas; Izawa, Jonathan I.; Lerner, Seth P.; Schoenberg, Mark; Stief, Christian G.; Skinner, Eila; Lotan, Yair; Sagalowsky, Arthur I; Shariat, Shahrokh F.

In: Journal of Urology, Vol. 183, No. 5, 05.2010, p. 1757-1763.

Research output: Contribution to journalArticle

Tilki, D, Reich, O, Svatek, RS, Karakiewicz, PI, Kassouf, W, Novara, G, Ficarra, V, Chade, DC, Fritsche, HM, Gerwens, N, Izawa, JI, Lerner, SP, Schoenberg, M, Stief, CG, Skinner, E, Lotan, Y, Sagalowsky, AI & Shariat, SF 2010, 'Characteristics and Outcomes of Patients With Clinical Carcinoma In Situ Only Treated With Radical Cystectomy: An International Study of 243 Patients', Journal of Urology, vol. 183, no. 5, pp. 1757-1763. https://doi.org/10.1016/j.juro.2010.01.025
Tilki, Derya ; Reich, Oliver ; Svatek, Robert S. ; Karakiewicz, Pierre I. ; Kassouf, Wassim ; Novara, Giacomo ; Ficarra, Vincenzo ; Chade, Daher C. ; Fritsche, Hans Martin ; Gerwens, Niklas ; Izawa, Jonathan I. ; Lerner, Seth P. ; Schoenberg, Mark ; Stief, Christian G. ; Skinner, Eila ; Lotan, Yair ; Sagalowsky, Arthur I ; Shariat, Shahrokh F. / Characteristics and Outcomes of Patients With Clinical Carcinoma In Situ Only Treated With Radical Cystectomy : An International Study of 243 Patients. In: Journal of Urology. 2010 ; Vol. 183, No. 5. pp. 1757-1763.
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AU - Svatek, Robert S.

AU - Karakiewicz, Pierre I.

AU - Kassouf, Wassim

AU - Novara, Giacomo

AU - Ficarra, Vincenzo

AU - Chade, Daher C.

AU - Fritsche, Hans Martin

AU - Gerwens, Niklas

AU - Izawa, Jonathan I.

AU - Lerner, Seth P.

AU - Schoenberg, Mark

AU - Stief, Christian G.

AU - Skinner, Eila

AU - Lotan, Yair

AU - Sagalowsky, Arthur I

AU - Shariat, Shahrokh F.

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N2 - Purpose: We describe the rate of up staging and the cancer specific outcomes of patients with carcinoma in situ refractory to transurethral resection with intravesical therapy treated with radical cystectomy. Materials and Methods: The records of 3,207 patients treated with radical cystectomy for urothelial carcinoma of the bladder at 8 centers in the United States, Canada and Europe were reviewed. Results: Of the 3,207 patients who underwent radical cystectomy 243 (7.6%) had clinical carcinoma in situ only disease before radical cystectomy. At radical cystectomy 117 patients (48.1%) had carcinoma in situ only, 20 (8.2%) had pT0 urothelial carcinoma of the bladder, 19 (7.8%) had pTa urothelial carcinoma of the bladder and 36% had disease up staged (32 [13.2%] pT1, 29 [11.9%] pT2, 12 [4.9%] pT3 and 14 [5.8%] pT4). A total of 22 patients (9.1%) had lymphovascular invasion in the radical cystectomy specimen and 14 (5.8%) had metastasis to regional lymph nodes. Overall 5-year recurrence-free and cancer specific survival estimates were 74% (95% CI 68-79) and 85% (95% CI 80-89), respectively. On multivariable analysis adjusting for the effects of standard predictors, lymph node metastasis and lymphovascular invasion were associated with an increased risk of disease recurrence (p = 0.017 and p = 0.043, respectively) and cancer specific mortality (p = 0.019 and p = 0.001, respectively). Female gender was an independent risk factor for cancer specific mortality (p = 0.029) but not for disease recurrence (p = 0.173). Conclusions: Approximately a fourth of patients treated with radical cystectomy for clinical carcinoma in situ only had muscle invasive disease and 5.8% had metastasis to regional lymph nodes. Identification of those patients with a potentially aggressive natural history of carcinoma in situ is of the utmost importance as they are likely to benefit from early radical cystectomy.

AB - Purpose: We describe the rate of up staging and the cancer specific outcomes of patients with carcinoma in situ refractory to transurethral resection with intravesical therapy treated with radical cystectomy. Materials and Methods: The records of 3,207 patients treated with radical cystectomy for urothelial carcinoma of the bladder at 8 centers in the United States, Canada and Europe were reviewed. Results: Of the 3,207 patients who underwent radical cystectomy 243 (7.6%) had clinical carcinoma in situ only disease before radical cystectomy. At radical cystectomy 117 patients (48.1%) had carcinoma in situ only, 20 (8.2%) had pT0 urothelial carcinoma of the bladder, 19 (7.8%) had pTa urothelial carcinoma of the bladder and 36% had disease up staged (32 [13.2%] pT1, 29 [11.9%] pT2, 12 [4.9%] pT3 and 14 [5.8%] pT4). A total of 22 patients (9.1%) had lymphovascular invasion in the radical cystectomy specimen and 14 (5.8%) had metastasis to regional lymph nodes. Overall 5-year recurrence-free and cancer specific survival estimates were 74% (95% CI 68-79) and 85% (95% CI 80-89), respectively. On multivariable analysis adjusting for the effects of standard predictors, lymph node metastasis and lymphovascular invasion were associated with an increased risk of disease recurrence (p = 0.017 and p = 0.043, respectively) and cancer specific mortality (p = 0.019 and p = 0.001, respectively). Female gender was an independent risk factor for cancer specific mortality (p = 0.029) but not for disease recurrence (p = 0.173). Conclusions: Approximately a fourth of patients treated with radical cystectomy for clinical carcinoma in situ only had muscle invasive disease and 5.8% had metastasis to regional lymph nodes. Identification of those patients with a potentially aggressive natural history of carcinoma in situ is of the utmost importance as they are likely to benefit from early radical cystectomy.

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KW - prognosis

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KW - transitional cell

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