title: Concomitant carcinoma in situ in cystectomy specimens is not associated with clinical outcomes after surgery.
abstract: OBJECTIVE
  The aim of this study was to externally validate the prognostic value of concomitant urothelial carcinoma in situ (CIS) in radical cystectomy (RC) specimens using a large international cohort of bladder cancer patients.
  
  
  METHODS
  The records of 3,973 patients treated with RC and bilateral lymphadenectomy for urothelial carcinoma of the bladder (UCB) at nine centers worldwide were reviewed. Surgical specimens were evaluated by a genitourinary pathologist at each center. Uni- and multivariable Cox regression models addressed time to recurrence and cancer-specific mortality after RC.
  
  
  RESULTS
  1,741 (43.8%) patients had concomitant CIS in their RC specimens. Concomitant CIS was more common in organ-confined UCB and was associated with lymphovascular invasion (p < 0.001). Concomitant CIS was not associated with either disease recurrence or cancer-specific death regardless of pathologic stage. The presence of concomitant CIS did not improve the predictive accuracy of standard predictors for either disease recurrence or cancer-specific death in any of the subgroups.
  
  
  CONCLUSIONS
  We could not confirm the prognostic value of concomitant CIS in RC specimens. This, together with the discrepancy between pathologists in determining the presence of concomitant CIS at the morphologic level, limits the clinical utility of concomitant CIS in RC specimens for clinical decision-making.
authors.affiliation: Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Nuhn
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Eila
authors.initials: E
authors.lastname: Skinner
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Izawa
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Stefan C
authors.initials: SC
authors.lastname: Müller
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Colin P
authors.initials: CP
authors.lastname: Dinney
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D015653:Cystectomy; D005060:Europe; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009656:North America; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019459:Urothelium / Q000473:pathology / Q000601:surgery; D055815:Young Adult