Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ confined urothelial carcinoma following radical nephroureterectomy.
OBJECTIVE
Carcinoma in situ (CIS) is associated with increased risk of progression when found with high-grade non-muscle-invasive bladder cancer, yet its impact is less clear in the upper urinary tract. In the current study, we evaluated the impact of concomitant CIS on recurrence-free survival and cancer-specific survival following radical nephroureterectomy for upper tract urothelial carcinoma (UTUC).


METHODS
A multi-institutional retrospective cohort of 1,387 patients undergoing radical nephroureterectomy was identified. Concomitant CIS was defined as the presence of CIS in association with another pathologic stage; patients with CIS alone were excluded from the analysis. The presence of concomitant CIS served as the exposure variable with disease recurrence and cancer-specific mortality as the outcomes. Organ-confined disease was defined as AJCC/UICC stage II or lower.


RESULTS
Concomitant CIS was identified in 371 of 1,387 (26.7%) patients and was significantly more common in patients with a previous bladder cancer history, high grade, and high stage tumors. In a multivariable analysis, concomitant CIS was a predictor of disease recurrence (HR = 1.25, P = 0.04) and cancer specific mortality (HR = 1.34, P = 0.05) for patients with organ-confined UTUC, but not in the entire cohort. Other prognostic variables, such as grade, stage, lymphovascular invasion, and lymph node status, were associated with poorer overall and recurrence-free survival for all patients.


CONCLUSIONS
The presence of concomitant CIS in patients with organ-confined UTUC is associated with a higher risk of recurrent disease and cancer-specific mortality. This information may be useful in refining surveillance protocols and in more appropriate selection of patients for adjuvant chemotherapy.
Wheat
Jeffery C
JC
University of Michigan, Ann Arbor, MI 48109, USA. jefwheat@med.umich.edu
Weizer
Alon Z
AZ
Wolf
J Stuart
JS
Lotan
Yair
Y
Remzi
Mesut
M
Margulis
Vitaly
V
Wood
Christopher G
CG
Montorsi
Francesco
F
Roscigno
Marco
M
Kikuchi
Eiji
E
Zigeuner
Richard
R
Langner
Cord
C
Bolenz
Christian
C
Koppie
Theresa M
TM
Raman
Jay D
JD
Fernández
Mario
M
Karakiewizc
Pierre
P
Capitanio
Umberto
U
Bensalah
Karim
K
Patard
Jean-Jacques
JJ
Shariat
Shahrokh F
SF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009392:Nephrectomy / Q000379:methods; D010173:Palpation / Q000379:methods*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D014551:Urinary Tract / Q000601:surgery; D019459:Urothelium / Q000601:surgery*