Concomitant vs pure/primary CIS tied to shorter survival in patients with urothelial carcinoma
Urothelial carcinoma patients presenting with concomitant carcinoma in situ (CIS) appear to have a worse outcome than those presenting with pure/primary CIS, a recent study has found. This suggests that the two entities must be differentiated in the treatment decision process.
Of the 163 patients with CIS in the upper urinary tract managed by radical nephroureterectomy, 24.5 percent presented with pure/primary CIS. In the concomitant CIS cohort, the pathological diagnosis of the non-CIS region was pTa in 4.9 percent, pT1 in 22.8 percent, pT2 in 25.2 percent, pT3 in 44.7 percent and pT4 in 1.6 percent of patients.
The pure/primary CIS cohort had a higher sensitivity of a selective urine cytology test than the concomitant CIS group (60.0 percent vs 37.4 percent).
The 10-year estimated mean cancer-specific survival in the overall CIS cohort was 92.4 months (range, 83.7–101.0) at a median follow-up of 32 months. Patients with pure/primary CIS had a significantly longer 10-year estimated mean cancer-specific survival than those with concomitant CIS (111.8 months; range, 101.0–122.6 vs 85.89 months; range, 75.3–96.5; p=0.007).
To explore the biological and prognostic features of concomitant CIS vs those of pure/primary CIS, the authors extracted information from a multicentre upper tract urothelial carcinoma database and analysed data from Nishinihon Uro-Oncology Group, including patient age, gender, presence of bladder cancer and pT stage.
Clinicopathological features between the different subtypes were then compared. Cancer-specific and overall survival, as well as relative excess risk of death, were estimated according to CIS subtype.