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Survival of patients with carcinoma in situ of the urinary bladder
Author(s) -
Cheng Liang,
Cheville John C.,
Neumann Roxann M.,
Leibovich Bradley C.,
Egan Kathleen S.,
Spotts Bruce E.,
Bostwick David G.
Publication year - 1999
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19990601)85:11<2469::aid-cncr24>3.0.co;2-u
Subject(s) - medicine , trigone of urinary bladder , carcinoma in situ , cystectomy , bladder cancer , carcinoma , proportional hazards model , cancer , urinary bladder , urology , urinary diversion , oncology
BACKGROUND To the authors' knowledge, the long term follow‐up of patients with carcinoma in situ of the urinary bladder is limited. METHODS The authors studied 138 patients diagnosed with urothelial carcinoma in situ of the bladder at the Mayo Clinic between 1972–1979. All the histologic slides were reviewed and fulfilled the diagnostic criteria for carcinoma in situ according to the newly proposed World Health Organization and International Society of Urologic Pathology classification system. None of these patients had previous or coexisting invasive urothelial carcinoma at the time of diagnosis. Cox proportional hazards models were used to determine the prognostic significance of numerous clinical and pathologic findings using progression free, cancer specific, and all‐cause survival as the endpoints for analysis. Progression was defined as the development of invasive carcinoma, distant metastases, or death from bladder carcinoma. RESULTS The patients ages at the time of diagnosis ranged from 32–90 years (mean, 65.6 years). The male to female ratio was 7:1. Carcinoma in situ usually was multifocal (50%) with a predilection for the trigone, lateral wall, and dome. The mean follow‐up after surgery was 11.0 years (range, 0.7–25 years). Actuarial progression free, cancer specific, and all‐cause survival rates were 63%, 79%, and 55%, respectively, at 10 years, and 59%, 74%, and 40%, respectively, at 15 years. The mean interval from the time of diagnosis to cancer progression was 5 years. Patient age at diagnosis was significant in predicting progression free ( P = 0.01) and all‐cause survival ( P = 0.002). Cystectomy performed within 3 months after the initial diagnosis was associated with improved all‐cause survival ( P = 0.03). After controlling for age, there was no difference in survival between patients who received immediate cystectomy and those did not ( P = 0.16). CONCLUSIONS Patients with carcinoma in situ of the bladder are at significant risk of cancer progression and death from bladder carcinoma. Cystectomy does not appear to offer a significant survival advantage in patients with carcinoma in situ of the bladder after adjusting for age. Cancer 1999;85:2469–74. © 1999 American Cancer Society.