Abstract
Objectives
To report the long-term oncological efficacy of radical cystectomy for patients with presumed clinical CIS only disease, to characterize the likelihood of clinical understaging, and to characterize the pattern of recurrence.
Methods
One thousand six hundred patients have undergone radical cystectomy and pelvic lymph node dissection with intent to cure from August 1971 to December 2005 at the University of Southern California; 27 patients from this cohort who satisfied both the inclusion and exclusion criteria were identified. Relevant clinical and pathological data at time of cystectomy and during follow-up were reported. Overall and recurrence-free survival was estimated using the Kaplan–Meier method.
Results
At time of cystectomy, 33% of patients were found to be clinically understaged. Median follow-up was 94 months. Estimated 5- and 10-year overall survival was 87 and 56%, respectively. Estimated 5- and 10-year recurrence-free survival was 100 and 83%, respectively.
Conclusions
Excellent long-term survival outcomes can be achieved with radical cystectomy. Radical cystectomy should be strongly considered for patients who have failed prior intravesical therapy. Long-term surveillance of the retained urethra and of the upper tract is essential, as recurrence can occur years following cystectomy. Patients who recur are at high risk of dying from disease.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lamm DL (1992) Carcinoma in situ. Urol Clin North Am 19:499–508
Wolf H, Melsen F, Pedersen SE, Nielsen KT (1994) Natural history of carcinoma in situ of the urinary bladder. Scand J Urol Nephrol Suppl 157:147–151
Griffiths TR, Charlton M, Neal DE, Powell PH (2002) Treatment of carcinoma in situ with intravesical bacillus Calmette-Guerin without maintenance. J Urol 167:2408–2412. doi:10.1016/S0022-5347(05)64994-4
Sylvester RJ, van der MA, Lamm DL (2002) Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol 168:1964–1970. doi:10.1016/S0022-5347(05)64273-5
Witjes JA (2004) Bladder carcinoma in situ in 2003: state of the art. Eur Urol 45:142–146. doi:10.1016/j.eururo.2003.09.013
Schrier BP, Hollander MP, van Rhijn BW, Kiemeney LA, Witjes JA (2004) Prognosis of muscle-invasive bladder cancer: difference between primary and progressive tumours and implications for therapy. Eur Urol 45:292–296. doi:10.1016/j.eururo.2003.10.006
Stein JP, Quek ML, Skinner DG (2004) Lymphadenectomy for invasive bladder cancer. II. Technical aspects and prognostic factors. BJU Int 97:232–237. doi:10.1111/j.1464-410X.2006.05901.x
Stein JP, Skinner DG (2004) Surgical atlas. Radical cystectomy. BJU Int 94:197–221. doi:10.1111/j.1464-410X.2004.04981.x
Stein JP, Skinner DG (2006) Surgical Atlas: the orthotopic T-pouch ileal neobladder. BJU Int 98:469–482. doi:10.1111/j.1464-410X.2006.06383.x
Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, Skinner E, Bochner B, Thangathurai D, Mikhail M et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1, 054 patients. J Clin Oncol 19:666–675
Huguet J, Crego M, Sabate S, Salvador J, Palou J, Villavicencio H (2005) Cystectomy in patients with high risk superficial bladder tumors who fail intravesical BCG therapy: pre-cystectomy prostate involvement as a prognostic factor. Eur Urol 48:53–59. doi:10.1016/j.eururo.2005.03.021 (discussion 59)
Revelo MP, Cookson MS, Chang SS, Shook MF, Smith JA Jr, Shappell SB (2004) Incidence and location of prostate and urothelial carcinoma in prostates from cystoprostatectomies: implications for possible apical sparing surgery. J Urol 171:646–651. doi:10.1097/01.ju.0000107380.40481.bc
Reese JH, Freiha FS, Gelb AB, Lum BL, Torti FM (1992) Transitional cell carcinoma of the prostate in patients undergoing radical cystoprostatectomy. J Urol 147:92–95
Solsona E, Iborra I, Rubio J, Casanova J, Almenar S (2004) The optimum timing of radical cystectomy for patients with recurrent high-risk superficial bladder tumour. BJU Int 94:1258–1262. doi:10.1111/j.1464-410X.2004.05228.x
Herr HW, Donat SM (1999) Prostatic tumor relapse in patients with superficial bladder tumors: 15-year outcome. J Urol 161:1854–1857. doi:10.1016/S0022-5347(05)68826-X
Sanderson KM, Cai J, Miranda G, Skinner DG, Stein JP (2007) Upper tract urothelial recurrence following radical cystectomy for transitional cell carcinoma of the bladder: an analysis of 1, 069 patients with 10-year followup. J Urol 177:2088–2094. doi:10.1016/j.juro.2007.01.133
Tran W, Serio AM, Raj GV, Dalbagni G, Vickers AJ, Bochner BH, Herr H, Donat SM (2008) Longitudinal risk of upper tract recurrence following radical cystectomy for urothelial cancer and the potential implications for long-term surveillance. J Urol 179:96–100. doi:10.1016/j.juro.2007.08.131
Freeman JA, Tarter TA, Esrig D, Stein JP, Elmajian DA, Chen SC, Groshen S, Lieskovsky G, Skinner DG (1996) Urethral recurrence in patients with orthotopic ileal neobladders. J Urol 156:1615–1619. doi:10.1016/S0022-5347(01)65462-4
Herr HW, Sogani PC (2001) Does early cystectomy improve the survival of patients with high risk superficial bladder tumors? J Urol 166:1296–1299. doi:10.1016/S0022-5347(05)65756-4
Conflict of interest statement
There is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Huang, G.J., Kim, P.H., Skinner, D.G. et al. Outcomes of patients with clinical CIS-only disease treated with radical cystectomy. World J Urol 27, 21–25 (2009). https://doi.org/10.1007/s00345-008-0344-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-008-0344-2