title: Prognostic effect of urinary bladder carcinoma in situ on clinical outcome of subsequent upper tract urothelial carcinoma.
abstract: OBJECTIVE
  To evaluate the effect of a history of bladder carcinoma in situ (CIS) on relapse and survival after surgical management of metachronous upper tract urothelial carcinoma (UTUC). Urinary bladder CIS was previously reported to be among the independent risk factors for the development of UTUC.
  
  
  METHODS
  Using a multi-institutional database of patients treated with radical nephroureterectomy (RNU) for UTUC, we compared the clinicopathologic parameters and clinical outcomes of patients with and without a history of bladder CIS. Multivariate Cox regression analysis was performed to determine the independent predictors of disease recurrence and cancer-specific mortality after RNU.
  
  
  RESULTS
  The study included 1316 patients, 884 men and 432 women, with median follow-up of 36 months after RNU. The patients with a history of bladder CIS (n = 91) were more likely to have high-grade and sessile UTUC (P < .05). The 5 year disease-free survival and cancer-specific survival rate was 53% and 59% in those with a history of bladder CIS and 71% and 75% in those without a history of bladder CIS, respectively (P = .031 and P = .045, respectively). On multivariate Cox regression analysis, a history of bladder CIS was an independent predictor of disease recurrence and cancer-specific mortality after RNU (P = .006 and P = .045, respectively).
  
  
  CONCLUSIONS
  The results of our study have shown that patients with a history of bladder CIS are more likely to develop aggressive UTUC and demonstrate a greater risk of recurrence and death from cancer after RNU. Our findings suggest the need for aggressive surveillance regimens and multimodal management strategies for patients who develop UTUC in the setting of previous bladder CIS.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
authors.forename: Ramy F
authors.initials: RF
authors.lastname: Youssef
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D016609:Neoplasms, Second Primary / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D014571:Urologic Neoplasms / Q000401:mortality* / Q000601:surgery