Concomitant Carcinoma in situ in Cystectomy Specimens Is Not Associated with Clinical Outcomes after Surgery

Objective: The aim of this study was to externally validate the
prognostic value of concomitant urothelial carcinoma in situ (CIS)
in radical cystectomy (RC) specimens using a large international
cohort of bladder cancer patients. Methods: The records of 3,973
patients treated with RC and bilateral lymphadenectomy for
urothelial carcinoma of the bladder (UCB) at nine centers worldwide
were reviewed. Surgical specimens were evaluated by a genitourinary
pathologist at each center. Uni- and multivariable Cox regression
models addressed time to recurrence and cancer-specific mortality
after RC. Results: 1,741 (43.8%) patients had concomitant CIS in
their RC specimens. Concomitant CIS was more common in
organ-confined UCB and was associated with lymphovascular invasion
(p < 0.001). Concomitant CIS was not associated with either
disease recurrence or cancer-specific death regardless of
pathologic stage. The presence of concomitant CIS did not improve
the predictive accuracy of standard predictors for either disease
recurrence or cancer-specific death in any of the subgroups.
Conclusions: We could not confirm the prognostic value of
concomitant CIS in RC specimens. This, together with the
discrepancy between pathologists in determining the presence of
concomitant CIS at the morphologic level, limits the clinical
utility of concomitant CIS in RC specimens for clinical
decision-making. Copyright (C) 2011 S. Karger AG, Basel