Tritschler, S., Zaak, D., Karl, A., Bader, M., Tilki, D., Knuechel, R., Hartmann, A., Stief, C.

Presented on March 21, 2007

Introduction & Objectives: Carcinoma in situ (CIS) of the urinary bladder is classified by the WHO as a flat lesion of the urothelium that is genetically instable. Primary, secondary and concurrent CIS are distinguishable. Reliable clinical information on this entity are rare due to its low incidence. We report on the followup of a series of patients with CIS from our institution. 

Material & Methods: Validation of the clinical parameters of all patients with an CIS within the years 1994-2005, analysis of the subgroups of primary, secondary and concurrent CIS, and analysis of the outcome depending on the therapy. 

Results: Within the reported time, 1439 patients were treated due to a bladder carcinoma in our institution. 113 of them (=7.9 %, 94 m, 19f, age: 67.2a [40-93]) had a CIS with a median followup time of 27.6 ? 21.22 months (2-101). 16.8%  (n=19) had a primary CIS, 20.3% (n=23 ) had a secondary CIS and 61.1% (n=69) presented with a concurrent CIS. All of them underwent TURB/biopsy. But in n=11 (9.7%) patients, CIS was discovered first in the cystectomy specimen. 54 of all patients received BCG instillation, but 35 of those (=65%) suffered from recurrence. Of these patients, 13 underwent cystectomy, 2 photodynamic therapy and 3 received radiation or chemotherapy. In all 39 patients (37.5%) underwent cystectomy, and 15% of the patients (n=17) had progression to invasive disease in the time of observation. Only two of the patients died from bladder cancer. 

Conclusions: The clinical data of this large series demonstrate that patients with a CIS represent a inhomogenous population. The risk of progression underlines the necessitity of a reliable and early diagnosis (FE by the means of fluorescence endoscopy) and adequate treatment of CIS. Further molecular investigations in our population have to prove if it is possible to distinguish between different CIS-subgroups with different risks of progression.

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