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Minerva Urologica e Nefrologica 2019 August;71(4):406-12

DOI: 10.23736/S0393-2249.19.03254-5

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

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 1, Massimo LAZZERI 1, Alberto SAITA 1 , Angelo NASELLI 2, Andrea GUARNERI 3, Nicolò M. BUFFI 1, Giovanni LUGHEZZANI 1, Vittorio FASULO 1, Giulio M. MONDELLINI 1, Marco PACIOTTI 1, Luigi DOMANICO 1, Roberto PESCHECHERA 1, Alessio BENETTI 1, Silvia ZANDEGIACOMO 1, Giuliana LISTA 1, Luisa PASINI 1, Giorgio GUAZZONI 1, 4, Paolo CASALE 1

1 Department of Urology, Humanitas Clinic IRCCS, Rozzano, Milan, Italy; 2 Unit of Urology, San Giuseppe Hospital, MultiMedica, Milan, Italy; 3 University Unit of Urology, San Giuseppe Hospital, MultiMedica, Milan, Italy; 4 Humanitas University, Pieve Emanuele, Milan, Italy



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.


KEY WORDS: Urinary bladder neoplasms; Carcinoma in situ; Progression-free survival

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