title: Impact of concomitant carcinoma in situ on upstaging and outcome following radical cystectomy for bladder cancer.
abstract: OBJECTIVE
  To evaluate the impact of concomitant carcinoma in situ (CIS) on upstaging and outcome of patients treated with radical cystectomy with pelvic lymph node dissection.
  
  
  METHODS
  We collected and pooled a database of 1,968 patients who have undergone radical cystectomy between 1998 and 2008 in eight academic centers across Canada. Collected variables included patient's age, gender, tumor grade, histology and the presence of concomitant CIS with either cTa-1 or cT2 disease, dates of recurrence and death.
  
  
  RESULTS
  In the presence of concomitant CIS, upstaging following radical cystectomy occurred in 48 and 55 % of patients with cTa-1 and cT2 disease, respectively. On univariate analysis, the presence of concomitant CIS with cT2 disease was associated with upstaging (p < 0.0001), and the presence of concomitant CIS with cTa-1 disease was also associated with upstaging but did not reach statistical significance (p = 0.0526). On multivariate analyses, the presence of concomitant CIS with either cTa-1 or cT2 tumors was independently prognostic of disease upstaging (p = 0.0001 and 0.0186, respectively). However, on multivariate analysis that incorporates pathologic stage, concomitant CIS was not significantly associated with worse overall, recurrence-free or disease-specific survival.
  
  
  CONCLUSIONS
  These results demonstrate that while the presence of concomitant CIS on cystectomy specimens does not independently affect outcomes, its presence is significantly predictive of a higher rate of upstaging at radical cystectomy.
authors.affiliation: Department of Surgery (Urology), McGill University, Montreal, QC, Canada, faysalyafi@gmail.com.
authors.forename: Faysal A
authors.initials: FA
authors.lastname: Yafi
authors.forename: Armen G
authors.initials: AG
authors.lastname: Aprikian
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Chin
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.forename: Jonathan
authors.initials: J
authors.lastname: Izawa
authors.forename: Eric
authors.initials: E
authors.lastname: Estey
authors.forename: Adrian
authors.initials: A
authors.lastname: Fairey
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rendon
authors.forename: Ilias
authors.initials: I
authors.lastname: Cagiannos
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Lattouf
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.forename: David
authors.initials: D
authors.lastname: Bell
authors.forename: Darrel
authors.initials: D
authors.lastname: Drachenberg
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*