Predictive factors for progression of patients with carcinoma in situ of the bladder at long-term follow-up: pure versus non-pure Cis

BACKGROUND: To identify the predictive factors for progression defined as any event that shifted the management of the disease from a bladder sparing approach, comparing patients with pure versus non-pure carcinoma in situ (Cis) of the bladder.METHODS: Retrospective analysis of consecutive patients affected by newly diagnosed pure Cis and non pure Cis (excluding cases with concomitant muscle invasive cancer). All patients were enrolled a in our institution from 1998 to 2010. Data was prospectively collected. Main end point was progression free survival.RESULTS: Overall, 149 patients with Cis were identified for the analysis. A total of 98 patients had pure Cis (66%). Median follow up was 103 months, range 40 -206. Progression occurred in 29 patients (19%). A total of 30 patients died during the follow-up (20%). In 13 cases (9%), the death was cancer specific. Progression free survival estimate was 181 months (95% confidence interval 169 -193) and 154 months (95% confidence interval 133 -176) respectively for pure and non-pure Cis population (p 0.03). Among examined variables (age, gender, symptoms, smoking habit, ASA score, number of BCG instillations), multivariate analysis disclosed that only Cis type was an independent predictor of progression (p 0.03) with a relative risk of 0.37 in favour of pure Cis.CONCLUSIONS: Pure Cis and non-pure Cis are efficiently treated by BCG therapy combined with transurethralresection and/or radical cystectomy, with relatively low rate of progression. Cis type was the onlysignificant predictor of progression.