Impact of clinical and pathological subtypes of carcinoma in situ (CIS) of the bladder: Lessons learned from long-term follow-up of a series of CIS patients treated with BCG

• Published in: Urologic oncology 2022-01, Vol.40 (1), p.9.e9-9.e17
• Main Authors: Subiela, José Daniel, Faba, Óscar Rodríguez, Aumatell, Julia, Krajewski, Wojciech, Calderón, Julio, Parada, Rubén, Huguet, Jorge, Algaba, Ferran, Breda, Alberto, Palou, Joan
• Format: Article
• Language: English
• Subjects: Adjuvants, Immunologic - therapeutic use; Aged; BCG immunotherapy; BCG Vaccine - therapeutic use; Carcinoma in situ; Carcinoma in Situ - classification; Carcinoma in Situ - diagnosis; Carcinoma in Situ - drug therapy; Carcinoma in Situ - mortality; Disease-Free Survival; Female; Follow-Up Studies; Humans; Male; Non-muscle-invasive bladder cancer; Retrospective Studies; Survival Rate; Time Factors; Treatment Outcome; Urinary Bladder Neoplasms - classification; Urinary Bladder Neoplasms - diagnosis; Urinary Bladder Neoplasms - drug therapy; Urinary Bladder Neoplasms - mortality
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2021.05.006

•According to the C-classification, 34 (8.8%) patients had P-CIS, 81 (21%) S-CIS, and 271 (70.2%) C-CIS.•According to the P-classification, 34 (8.8%) patients had P-CIS, 190 (49.2%) cTa-CIS, and 162 (42%) cT1-CIS.•Among the entire cohort, BCG response was reported in 296 (76.7%); 159 (41.2%) had recurrence, 55 (14.2%) had progression, and 67 (17.4%) underwent radical cystectomy. Death from any cause was recorded in 135 (35%) and death from urothelial carcinoma in 38 (9.9%).•Cox multivariate analysis showed neither C-classification nor P-classification to be an independent predictive factor for BCG response, RFS, PFS, OS, or CSS after adjusting for confounders.•The pooled meta-analysis showed no statistically significant difference across the groups for either C-classification or P-classification with respect to BCG response, RFS, PFS, or CSS. Some attempts have previously been made to stratify patients with CIS for the purpose of risk-adapted clinical management and clinical trial design. In particular, two classification systems have been proposed: clinical classification, comprising primary (P-CIS), concomitant (C-CIS), and secondary (S-CIS) disease, and pathological classification, comprising P-CIS, cTa-CIS, and cT1-CIS. The aim of the present study was to assess the impact of both classifications on BCG response, recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS). We performed a retrospective analysis of 386 patients with bladder CIS, with or without associated cTa/cT1 disease, treated with BCG instillations between 2008 and 2015. Patients were stratified according to the two classification systems. Cox multivariate regression models were used to assess the impact of these subtypes on BCG response, RFS, PFS, OS, and CSS. We also performed a cumulative meta-analysis according to PRISMA guidelines. The median follow-up was 70.5 months. According to the clinical classification, 34 (8.8%) patients had P-CIS, 81 (21%) S-CIS, and 271 (70.2%) C-CIS. The pathological classification showed 34 (8.8%) patients to have P-CIS, 190 (49.2%) cTa-CIS, and 162 (42%) cT1-CIS. In the overall cohort, BCG response was reported in 296 (76.7%); 159 (41.2%) had recurrence, 55 (14.2%) had progression, and 67 (17.4%) underwent radical cystectomy. Death from any cause was recorded in 135 (35%) and death from urothelial carcinoma in 38 (9.9%). Cox multivariate regression analysis showed that neither clinical c