Clinical outcomes of primary bladder carcinoma in situ in a contemporary series Journal Article


Authors: Chade, D. C.; Shariat, S. F.; Godoy, G.; Savage, C. J.; Cronin, A. M.; Bochner, B. H.; Donat, S. M.; Herr, H. W.; Dalbagni, G.
Article Title: Clinical outcomes of primary bladder carcinoma in situ in a contemporary series
Abstract: Purpose: The natural history of primary bladder carcinoma in situ has not been well described. We describe patterns of disease recurrence and progression, and identify clinical outcome predictors of primary carcinoma in situ after bacillus Calmette-Guerin therapy. Materials and Methods: We performed a retrospective analysis of 155 patients diagnosed with isolated primary high grade carcinoma in situ at a tertiary center from 1990 to 2008 who underwent transurethral resection followed by intravesical bacillus Calmette-Guerin therapy. The end points included time to disease recurrence, time to progression to invasive disease (cT1 or higher) or to muscle invasive disease (cT2 or higher), or early radical cystectomy. Predictors included gender, age, race, smoking history, presenting symptoms, carcinoma in situ pattern (focal, multiple or diffuse) and response to bacillus Calmette-Guerin. Results: A total of 155 patients received bacillus Calmette-Guerin therapy within 6 months. The 5-year cumulative incidence of progression to cT1 or higher was 45% (95% CI 37-55) and to cT2 or higher was 17% (95% CI 12-25) adjusting for the competing risk of radical cystectomy. Of 130 patients evaluated for response to bacillus Calmette-Guerin 81 (62%) were considered responders. Response to bacillus Calmette-Guerin was significantly associated with progression to cT1 or higher/radical cystectomy (HR 0.59, 95% CI 0.36-0.95, p = 0.029) and to cT2 or higher/radical cystectomy (HR 0.53, 95% CI 0.32-0.88, p = 0.015). This association was largely driven by the higher rate of early radical cystectomy among nonresponders. Conclusions: Despite bacillus Calmette-Guerin therapy and early radical cystectomy, patients with primary carcinoma in situ had a high rate of disease progression. Response to bacillus Calmette-Guerin was significantly associated with a lower rate of disease progression or early radical cystectomy. © 2010 American Urological Association Education and Research, Inc.
Keywords: adult; controlled study; treatment outcome; treatment response; aged; primary tumor; retrospective studies; major clinical study; cancer recurrence; cancer growth; cancer patient; combined modality therapy; outcome assessment; cancer incidence; bcg vaccine; cancer immunotherapy; neoplasm recurrence, local; logistic models; proportional hazards models; medical record review; urinary bladder neoplasms; hematuria; disease progression; carcinoma in situ; cystectomy; neoplasm metastasis; smoking habit; sex difference; neoplasm invasiveness; age distribution; transurethral resection; bladder carcinoma; race difference; bladder carcinoma in situ; course evaluation; micturition disorder
Journal Title: Journal of Urology
Volume: 184
Issue: 1
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2010-07-01
Start Page: 74
End Page: 80
Language: English
DOI: 10.1016/j.juro.2010.03.032
PUBMED: 20546806
PROVIDER: scopus
PMCID: PMC4226045
DOI/URL:
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: JOURA" - "Source: Scopus"
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MSK Authors
  1. Caroline Savage
    80 Savage
  2. Guido Dalbagni
    325 Dalbagni
  3. Sherri M Donat
    174 Donat
  4. Daher Chade
    19 Chade
  5. Shahrokh Shariat
    68 Shariat
  6. Angel M Cronin
    145 Cronin
  7. Bernard Bochner
    468 Bochner
  8. Harry W Herr
    594 Herr
  9. Guilherme Godoy
    23 Godoy