ORIGINAL ARTICLE   Free access

Minerva Urologica e Nefrologica 2019 August;71(4):406-12

DOI: 10.23736/S0393-2249.19.03254-5

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Predictive factors for progression of patients with carcinoma in situ of the bladder at long-term follow-up: pure versus non-pure CIS

Rodolfo HURLE ¹, Massimo LAZZERI ¹, Alberto SAITA ¹ ✉, Angelo NASELLI ², Andrea GUARNERI ³, Nicolò M. BUFFI ¹, Giovanni LUGHEZZANI ¹, Vittorio FASULO ¹, Giulio M. MONDELLINI ¹, Marco PACIOTTI ¹, Luigi DOMANICO ¹, Roberto PESCHECHERA ¹, Alessio BENETTI ¹, Silvia ZANDEGIACOMO ¹, Giuliana LISTA ¹, Luisa PASINI ¹, Giorgio GUAZZONI ^{1, 4}, Paolo CASALE ¹

¹ Department of Urology, Humanitas Clinic IRCCS, Rozzano, Milan, Italy; ² Unit of Urology, San Giuseppe Hospital, MultiMedica, Milan, Italy; ³ University Unit of Urology, San Giuseppe Hospital, MultiMedica, Milan, Italy; ⁴ Humanitas University, Pieve Emanuele, Milan, Italy

BACKGROUND: The aim of this study was to identify the predictive factors for progression defined as any event that shifted the management of the disease from a bladder sparing approach, by comparing patients with pure versus non-pure carcinoma in situ (CIS) of the bladder.
METHODS: A retrospective analysis was carried out in consecutive patients affected by newly-diagnosed pure CIS and non-pure CIS (excluding cases with concomitant muscle invasive cancer). All patients were enrolled a in our institution from 1998 to 2010. Data was prospectively collected. Main end point was progression-free survival.
RESULTS: Overall, 149 patients with CIS were identified for the analysis. A total of 98 patients had pure CIS (66%). Median follow-up was 103 months (range: 40-206 months). Progression occurred in 29 patients (19%). A total of 30 patients died during the follow-up (20%). In 13 cases (9%), the death was cancer specific. Progression-free survival estimate was 181 months (95% CI: 169-193 months) and 154 months (95% CI: 133-176 months) respectively for pure and non-pure CIS population (P=0.03). Among examined variables (age, gender, symptoms, smoking habit, ASA score, number of bacillus Calmette-Guérin [BCG] instillations), multivariate analysis disclosed that only CIS type was an independent predictor of progression (P=0.03) with a relative risk of 0.37 in favor of pure CIS.
CONCLUSIONS: Pure and non-pure CIS are efficiently treated by BCG therapy combined with trans-urethral resection and/or radical cystectomy, with relatively low rate of progression. CIS type was the only significant predictor of progression.

KEY WORDS: Urinary bladder neoplasms; Carcinoma in situ; Progression-free survival