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EAU 2018

EAU 2018: Prognostic Value of Concomitant Carcinoma in Situ in Radical Cystectomy Specimens on Patients with Bladder Cancer: A Meta-Analysis Of 24,136 Patients

Copenhagen, Denmark (UroToday.com) Carcinoma in situ (CIS) is a well-known risk factor for progression in patients with non-muscle invasive bladder cancer (NMIBC). The presence of CIS has also been identified as a poor prognostic factor for patients with invasive disease undergoing bladder-sparing therapy (TURBT+Chemo+XRT). The role of concomitant CIS in patients with invasive disease undergoing cystectomy remains largely unknown. In this poster presentation, the authors present a meta-analysis of assessing the association of   concomitant CIS in the radical cystectomy with overall survival (OS), recurrence free survival (RFS), cancer specific survival (CSS) and ureter involvement.

The meta-analysis consisted of 24 studies (including 24,136 patients) that assessed the oncological outcomes of patients treated with radical cystectomy. The studies were selected following a systematic review of the MEDLINE, SCOPUS, Web of Science and Cochrane Library databases. Studies were eligible if concomitant CIS in radical cystectomy specimens was reported and correlated the pathological findings with one or more of the oncological outcomes. Multivariate Cox regression or logistic regression analyses were performed to determine the association between concomitant CIS and the three oncologic outcomes. Following review, concomitant CIS was reported in 38.3% of patients. In studies including pT1-4 patients, concomitant CIS was not associated with OS (pooled HR, 0.98; 0.86-1.11), RFS (pooled HR, 1.06; 0.99-1.14) and CSS (pooled HR, 1.00; 0.93-1.07). Concomitant CIS was found to be associated with ureteral involvement (pooled OR, 4.51; 2.59-7.84). On subgroup analysis of patients with localized disease (n=1,041), concomitant CIS was associated with both RFS (pooled HR, 1.57; 1.12-2.21) and CSS (pooled HR, 1.51; 1.001-2.280).

In summary, concomitant CIS appears to be associated with worse RFS and CSS in patients with localized disease (pT1-T2), the biology related to this phenomenon remains unclear, but it correlates well with the high rate of nodal disease associated with patients with BCG refractory CIS. This study demonstrates the importance of careful pathological evaluation of the radical cystectomy specimen for concomitant CIS as it may play a significant role in the selection of patients for adjuvant therapy, especially in those who otherwise would have been considered cured (pT1-T2). 


Presented by: Shoji Kimura MD, Medical University of Vienna, Dept. of Urology, Vienna, Austria

Written by: Andres F. Correa, Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, PA at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark.