Outcomes in patients with pathological carcinoma in situ only disease at radical cystectomy

Abstract

Purpose: Pathological stage influences patient outcome after radical cystectomy. We present our experience with patients who have only transitional cell carcinoma in situ of the bladder (pCIS-only) on final pathological examination after radical cystectomy.

Materials and methods: Between August 1995 and June 2003, 576 patients underwent radical cystectomy at our institution. Of these patients 54 were pathological stage CIS-only on final cystectomy specimen. Four patients simultaneously had invasive transitional cell carcinoma of the ureter or renal pelvis and were excluded from evaluation. Variables examined included demographic characteristics, preoperative pathological stage, high risk features and followup parameters.

Results: Of the 50 patients with pCIS-only 44 (88%) were disease-free at last followup. Mean followup was 37.2 months (range 3.6 to 93.5). Of the 50 patients 21 had focal CIS while 29 had multifocal disease. There was no difference in disease recurrence between these 2 groups (9.5% vs 13.7%, p = 0.8). There were 9 patients with proximal urethral CIS involvement, of whom metastatic disease developed in 3. Only 1 of the 8 patients (12.5%) with ureteral orifice involvement had recurrence. Of the 50 patients 22 had muscle invasive disease on initial transurethral resection without residual invasive disease at cystectomy. This subset fared significantly worse after radical cystectomy than the 28 patients with less than stage T2 disease on transurethral bladder tumor resection (22.7% vs 3.6% metastasis, p < or = 0.05).

Conclusions: The outcome of patients who have pCIS-only after radical cystectomy is not uniform. Patients may be at higher risk for recurrence if disease extends to the proximal urethra. In addition, patients demonstrating invasion on clinical staging (stage T2 or greater) but subsequent pCIS-only disease have a worse prognosis compared to those with superficial clinical staging. Patients with CIS-only on clinical and pathological staging have an excellent disease-free survival with radical cystectomy even with the presence of multifocal disease.