The presence of carcinoma in situ at radical cystectomy increases the risk of urothelial recurrence: Implications for follow-up schemes

M Moschini, SF Shariat, M Abufaraj, Francesco Soria, T Klatte, Giovanni La Croce, Agostino Mattei, Rocco Damiano, A Salonia, F Montorsi, A Briganti, R Colombo, Andrea Gallina

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Abstract

Introduction: To evaluate the incidence of carcinoma in situ (CIS) in patients treated with radical cystectomy (RC) due to bladder cancer and to assess its effect on recurrence and survival rates. Methods: The study focused on 1,128 consecutive nonmetastatic patients with bladder cancer treated with RC at a single tertiary care referral center from 1994 to 2014. The Kaplan-Meier method was used to compare recurrence, cancer-specific mortality (CSM), and overall mortality-free rates in the overall population and in pT0-pT2 and pT3-pT4 patients after stratifying according to the presence of CIS. Multivariable (MVA) Cox regression analyses tested the effect of the presence of CIS on survival outcomes. MVA competing risk analyses were performed to assess the effect of CIS on urothelial recurrence. Results: The presence of CIS was reported in 277 (24.6%) patients. During a median follow-up of 6 years, 355 recurrences, 377 CSM, and 468 overall mortality were reported. At MVA Cox regression analyses, the presence of concomitant CIS was not associated with any survival effect when the overall population was considered (all . P≥0.3). At MVA Cox regression analyses, there was no effect of CIS on survival outcomes in pT3-pT4 patients (all . P>0.2); on the contrary, the presence of CIS was associated with worse CSM in pT0-pT2 patients only (hazard ratio [HR] = 1.82; CI: 1.01-3.29; . P = 0.04). At MVA competing risk analyses predicting urothelial recurrence only, the presence of CIS was associated to an increased risk of urothelial recurrence in pT0-pT2 patients (HR = 2.99; CI: 1.05-8.53; . P = 0.04), pT3-pT4 patients (HR = 10.29; CI: 1.40-75.75; . P = 0.02), and in the overall population (HR = 4.47; CI: 1.81-11.07; . P = 0.001). Conclusion: An increased risk of developing urothelial recurrence only was recorded in patients diagnosed with CIS at RC. Physicians should consider this aspect ensuring a more severe follow-up schemes in patients who harbored this pathological feature. © 2016 Elsevier Inc.
Original languageEnglish
Pages (from-to)151.e17-151.e23
JournalUrologic Oncology: Seminars and Original Investigations
Volume35
Issue number4
DOIs
Publication statusPublished - 2017

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Cystectomy
Carcinoma in Situ
Recurrence
Mortality
Regression Analysis
Urinary Bladder Neoplasms
Tertiary Care Centers
Survival
Population
Neoplasms
Survival Rate
Physicians

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The presence of carcinoma in situ at radical cystectomy increases the risk of urothelial recurrence: Implications for follow-up schemes. / Moschini, M; Shariat, SF; Abufaraj, M; Soria, Francesco; Klatte, T; La Croce, Giovanni; Mattei, Agostino; Damiano, Rocco; Salonia, A; Montorsi, F; Briganti, A; Colombo, R; Gallina, Andrea.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 35, No. 4, 2017, p. 151.e17-151.e23.

Research output: Contribution to journalArticle

Moschini, M ; Shariat, SF ; Abufaraj, M ; Soria, Francesco ; Klatte, T ; La Croce, Giovanni ; Mattei, Agostino ; Damiano, Rocco ; Salonia, A ; Montorsi, F ; Briganti, A ; Colombo, R ; Gallina, Andrea. / The presence of carcinoma in situ at radical cystectomy increases the risk of urothelial recurrence: Implications for follow-up schemes. In: Urologic Oncology: Seminars and Original Investigations. 2017 ; Vol. 35, No. 4. pp. 151.e17-151.e23.
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title = "The presence of carcinoma in situ at radical cystectomy increases the risk of urothelial recurrence: Implications for follow-up schemes",
abstract = "Introduction: To evaluate the incidence of carcinoma in situ (CIS) in patients treated with radical cystectomy (RC) due to bladder cancer and to assess its effect on recurrence and survival rates. Methods: The study focused on 1,128 consecutive nonmetastatic patients with bladder cancer treated with RC at a single tertiary care referral center from 1994 to 2014. The Kaplan-Meier method was used to compare recurrence, cancer-specific mortality (CSM), and overall mortality-free rates in the overall population and in pT0-pT2 and pT3-pT4 patients after stratifying according to the presence of CIS. Multivariable (MVA) Cox regression analyses tested the effect of the presence of CIS on survival outcomes. MVA competing risk analyses were performed to assess the effect of CIS on urothelial recurrence. Results: The presence of CIS was reported in 277 (24.6{\%}) patients. During a median follow-up of 6 years, 355 recurrences, 377 CSM, and 468 overall mortality were reported. At MVA Cox regression analyses, the presence of concomitant CIS was not associated with any survival effect when the overall population was considered (all . P≥0.3). At MVA Cox regression analyses, there was no effect of CIS on survival outcomes in pT3-pT4 patients (all . P>0.2); on the contrary, the presence of CIS was associated with worse CSM in pT0-pT2 patients only (hazard ratio [HR] = 1.82; CI: 1.01-3.29; . P = 0.04). At MVA competing risk analyses predicting urothelial recurrence only, the presence of CIS was associated to an increased risk of urothelial recurrence in pT0-pT2 patients (HR = 2.99; CI: 1.05-8.53; . P = 0.04), pT3-pT4 patients (HR = 10.29; CI: 1.40-75.75; . P = 0.02), and in the overall population (HR = 4.47; CI: 1.81-11.07; . P = 0.001). Conclusion: An increased risk of developing urothelial recurrence only was recorded in patients diagnosed with CIS at RC. Physicians should consider this aspect ensuring a more severe follow-up schemes in patients who harbored this pathological feature. {\circledC} 2016 Elsevier Inc.",
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TY - JOUR

T1 - The presence of carcinoma in situ at radical cystectomy increases the risk of urothelial recurrence: Implications for follow-up schemes

AU - Moschini, M

AU - Shariat, SF

AU - Abufaraj, M

AU - Soria, Francesco

AU - Klatte, T

AU - La Croce, Giovanni

AU - Mattei, Agostino

AU - Damiano, Rocco

AU - Salonia, A

AU - Montorsi, F

AU - Briganti, A

AU - Colombo, R

AU - Gallina, Andrea

PY - 2017

Y1 - 2017

N2 - Introduction: To evaluate the incidence of carcinoma in situ (CIS) in patients treated with radical cystectomy (RC) due to bladder cancer and to assess its effect on recurrence and survival rates. Methods: The study focused on 1,128 consecutive nonmetastatic patients with bladder cancer treated with RC at a single tertiary care referral center from 1994 to 2014. The Kaplan-Meier method was used to compare recurrence, cancer-specific mortality (CSM), and overall mortality-free rates in the overall population and in pT0-pT2 and pT3-pT4 patients after stratifying according to the presence of CIS. Multivariable (MVA) Cox regression analyses tested the effect of the presence of CIS on survival outcomes. MVA competing risk analyses were performed to assess the effect of CIS on urothelial recurrence. Results: The presence of CIS was reported in 277 (24.6%) patients. During a median follow-up of 6 years, 355 recurrences, 377 CSM, and 468 overall mortality were reported. At MVA Cox regression analyses, the presence of concomitant CIS was not associated with any survival effect when the overall population was considered (all . P≥0.3). At MVA Cox regression analyses, there was no effect of CIS on survival outcomes in pT3-pT4 patients (all . P>0.2); on the contrary, the presence of CIS was associated with worse CSM in pT0-pT2 patients only (hazard ratio [HR] = 1.82; CI: 1.01-3.29; . P = 0.04). At MVA competing risk analyses predicting urothelial recurrence only, the presence of CIS was associated to an increased risk of urothelial recurrence in pT0-pT2 patients (HR = 2.99; CI: 1.05-8.53; . P = 0.04), pT3-pT4 patients (HR = 10.29; CI: 1.40-75.75; . P = 0.02), and in the overall population (HR = 4.47; CI: 1.81-11.07; . P = 0.001). Conclusion: An increased risk of developing urothelial recurrence only was recorded in patients diagnosed with CIS at RC. Physicians should consider this aspect ensuring a more severe follow-up schemes in patients who harbored this pathological feature. © 2016 Elsevier Inc.

AB - Introduction: To evaluate the incidence of carcinoma in situ (CIS) in patients treated with radical cystectomy (RC) due to bladder cancer and to assess its effect on recurrence and survival rates. Methods: The study focused on 1,128 consecutive nonmetastatic patients with bladder cancer treated with RC at a single tertiary care referral center from 1994 to 2014. The Kaplan-Meier method was used to compare recurrence, cancer-specific mortality (CSM), and overall mortality-free rates in the overall population and in pT0-pT2 and pT3-pT4 patients after stratifying according to the presence of CIS. Multivariable (MVA) Cox regression analyses tested the effect of the presence of CIS on survival outcomes. MVA competing risk analyses were performed to assess the effect of CIS on urothelial recurrence. Results: The presence of CIS was reported in 277 (24.6%) patients. During a median follow-up of 6 years, 355 recurrences, 377 CSM, and 468 overall mortality were reported. At MVA Cox regression analyses, the presence of concomitant CIS was not associated with any survival effect when the overall population was considered (all . P≥0.3). At MVA Cox regression analyses, there was no effect of CIS on survival outcomes in pT3-pT4 patients (all . P>0.2); on the contrary, the presence of CIS was associated with worse CSM in pT0-pT2 patients only (hazard ratio [HR] = 1.82; CI: 1.01-3.29; . P = 0.04). At MVA competing risk analyses predicting urothelial recurrence only, the presence of CIS was associated to an increased risk of urothelial recurrence in pT0-pT2 patients (HR = 2.99; CI: 1.05-8.53; . P = 0.04), pT3-pT4 patients (HR = 10.29; CI: 1.40-75.75; . P = 0.02), and in the overall population (HR = 4.47; CI: 1.81-11.07; . P = 0.001). Conclusion: An increased risk of developing urothelial recurrence only was recorded in patients diagnosed with CIS at RC. Physicians should consider this aspect ensuring a more severe follow-up schemes in patients who harbored this pathological feature. © 2016 Elsevier Inc.

U2 - 10.1016/j.urolonc.2016.11.003

DO - 10.1016/j.urolonc.2016.11.003

M3 - Article

VL - 35

SP - 151.e17-151.e23

JO - Urologic Oncology

JF - Urologic Oncology

SN - 1078-1439

IS - 4

ER -