Survival of patients with carcinoma in situ of the urinary bladder

BACKGROUND. To the authors' knowledge, the long term follow-up of patients with carcinoma in situ of the urinary bladder is limited. METHODS. The authors studied 138 patients diagnosed with urothelial carcino ma in situ of the bladder at the Mayo Clinic between 1972-1979. All the his tologic slides were reviewed and fulfilled the diagnostic criteria for carc inoma in situ according to the newly proposed World Health Organization and International Society of Urologic Pathology classification system. None of these patients had previous or coexisting invasive urothelial carcinoma at the time of diagnosis. Cox proportional hazards models were used to determ ine the prognostic significance of numerous clinical and pathologic finding s using progression free, cancer specific, and all-cause survival as the en dpoints for analysis. Progression was defined as the development of invasiv e carcinoma, distant metastases, or death from bladder carcinoma. RESULTS. The patients ages at the time of diagnosis ranged from 32-90 years (mean, 65.6 years). The male to female ratio was 7:1. Carcinoma in situ us ually was multifocal (50%) with a predilection for the trigone, lateral wal l, and dome. The mean follow-up after surgery was 11.0 years (range, 0.7-25 years). Actuarial progression free, cancer specific, and all-cause surviva l rates were 63%, 79%, and 55%, respectively, at 10 years, and 59%, 74%, an d 40%, respectively, at 15 years. The mean interval from the time of diagno sis to cancer progression was 5 years. Patient age at diagnosis was signifi cant in predicting progression free (P = 0.01) and all-cause survival (P = 0.002). Cystectomy performed within 3 months after the initial diagnosis wa s associated with improved all-cause survival (P = 0.03). After controlling for age, there was no difference in survival between patients who received immediate cystectomy and those did not (P = 0.16). CONCLUSIONS. Patients with carcinoma in situ of the bladder are at signific ant risk of cancer progression and death from bladder carcinoma. Cystectomy does not appear to offer a significant survival advantage in patients with carcinoma in situ of the bladder after adjusting for age. Cancer 1999;85:2 469-74. (C) 1999 American Cancer Society.