title: Prognostic Effect of Carcinoma In Situ in Muscle-invasive Urothelial Carcinoma Patients Receiving Neoadjuvant Chemotherapy.
abstract: Carcinoma in situ (CIS) is a poor prognostic finding in urothelial carcinoma. However, its significance in muscle-invasive urothelial carcinoma (MIUC) treated with neoadjuvant chemotherapy (NAC) is uncertain. We assessed the effect of CIS found in pretreatment transurethral resection of bladder tumor (TURBT) biopsies on the pathologic and clinical outcomes.
  
  
  
  Subjects with MIUC treated with NAC before cystectomy were identified. The pathologic complete response (pCR) rates stratified by TURBT CIS status were compared. The secondary analyses included tumor response, progression-free survival (PFS), overall survival (OS), and an exploratory post hoc analysis of patients with pathologic CIS only (pTisN0) at cystectomy.
  
  
  
  A total of 137 patients with MIUC were identified. TURBT CIS was noted in 30.7% of the patients. The absence of TURBT CIS was associated with a significantly increased pCR rate (23.2% vs. 9.5%; odds ratio, 4.08; 95% confidence interval, 1.19-13.98; P = .025). Stage pTisN0 disease was observed in 19.0% of the TURBT CIS patients. TURBT CIS status did not significantly affect the PFS or OS outcomes. Post hoc analysis of the pTisN0 patients revealed prolonged median PFS (104.5 vs. 139.9 months; P = .055) and OS (104.5 vs. 152.3 months; P = .091) outcomes similar to those for the pCR patients.
  
  
  
  The absence of CIS on pretreatment TURBT in patients with MIUC undergoing NAC was associated with increased pCR rates, with no observed differences in PFS or OS. Isolated CIS at cystectomy was frequently observed, with lengthy PFS and OS durations similar to those for pCR patients. Further studies aimed at understanding the biology and clinical effect of CIS in MIUC are warranted.
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Derek E
authors.initials: DE
authors.lastname: Thomas
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Hristos Z
authors.initials: HZ
authors.lastname: Kaimakliotis
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Rice
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Pereira
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Paul
authors.initials: P
authors.lastname: Johnston
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Marietta L
authors.initials: ML
authors.lastname: Moore
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Angela
authors.initials: A
authors.lastname: Reed
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Dylan M
authors.initials: DM
authors.lastname: Cregar
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Cindy
authors.initials: C
authors.lastname: Franklin
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Rhoda L
authors.initials: RL
authors.lastname: Loman
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Koch
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Richard
authors.initials: R
authors.lastname: Bihrle
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Masterson
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gardner
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Chandru P
authors.initials: CP
authors.lastname: Sundaram
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Powell
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Stephen D W
authors.initials: SDW
authors.lastname: Beck
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: David J
authors.initials: DJ
authors.lastname: Grignon
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Costantine
authors.initials: C
authors.lastname: Albany
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: nhahn4@jhmi.edu.
authors.forename: Noah M
authors.initials: NM
authors.lastname: Hahn
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002278:Carcinoma in Situ / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D002945:Cisplatin / Q000627:therapeutic use*; D015653:Cystectomy; D018572:Disease-Free Survival; D004358:Drug Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: CIS; NAC; Pathologic complete response; Transurethral resection of bladder tumor; UC