Predictive factors for progression of patients with carcinoma in situ of the bladder at long-term follow-up: pure versus non-pure CIS

Rodolfo Hurle, Massimo Lazzeri, Alberto Saita, Angelo Naselli, Andrea Guarneri, Nicolò M Buffi, Giovanni Lughezzani, Vittorio Fasulo, Giulio M Mondellini, Marco Paciotti, Luigi Domanico, Roberto Peschechera, Alessio Benetti, Silvia Zandegiacomo, Giuliana Lista, Luisa Pasini, Giorgio Guazzoni, Paolo Casale

Research output: Contribution to journalArticlepeer-review


BACKGROUND: The aim of this study was to identify the predictive factors for progression defined as any event that shifted the management of the disease from a bladder sparing approach, by comparing patients with pure versus non-pure carcinoma in situ (CIS) of the bladder.

METHODS: A retrospective analysis was carried out in consecutive patients affected by newly-diagnosed pure CIS and non-pure CIS (excluding cases with concomitant muscle invasive cancer). All patients were enrolled a in our institution from 1998 to 2010. Data was prospectively collected. Main end point was progression-free survival.

RESULTS: Overall, 149 patients with CIS were identified for the analysis. A total of 98 patients had pure CIS (66%). Median follow-up was 103 months (range: 40-206 months). Progression occurred in 29 patients (19%). A total of 30 patients died during the follow-up (20%). In 13 cases (9%), the death was cancer specific. Progression-free survival estimate was 181 months (95% CI: 169-193 months) and 154 months (95% CI: 133-176 months) respectively for pure and non-pure CIS population (P=0.03). Among examined variables (age, gender, symptoms, smoking habit, ASA score, number of bacillus Calmette-Guérin [BCG] instillations), multivariate analysis disclosed that only CIS type was an independent predictor of progression (P=0.03) with a relative risk of 0.37 in favor of pure CIS.

CONCLUSIONS: Pure and non-pure CIS are efficiently treated by BCG therapy combined with trans-urethral resection and/or radical cystectomy, with relatively low rate of progression. CIS type was the only significant predictor of progression.

Original languageEnglish
Pages (from-to)406-412
Number of pages7
JournalMinerva urologica e nefrologica = The Italian journal of urology and nephrology
Issue number4
Publication statusPublished - Aug 2019


  • Aged
  • Aged, 80 and over
  • BCG Vaccine/therapeutic use
  • Carcinoma in Situ/mortality
  • Combined Modality Therapy
  • Cystectomy
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Predictive Value of Tests
  • Prognosis
  • Progression-Free Survival
  • Retrospective Studies
  • Risk Factors
  • Urinary Bladder Neoplasms/mortality
  • Urologic Surgical Procedures


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