Commentary on “Prognostic effect of carcinoma in situ in muscle-invasive urothelial carcinoma patients receiving neoadjuvant chemotherapy.”

D. E. Thomas, Hristos Kaimakliotis, K. R. Rice, J. A. Pereira, P. Johnston, M. L. Moore, A. Reed, D. M. Cregar, C. Franklin, R. L. Loman, Michael Koch, Richard Bihrle, Richard Foster, Timothy Masterson, T. A. Gardner, Chandru Sundaram, Charles Powell, S. D.W. Beck, David Grignon, L. Cheng & 2 others Costantine Albany, N. M. Hahn

Research output: Contribution to journalArticle

Abstract

Background: 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. Materials and methods: 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. Results: 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% CI: 1.19–13.98; P = 0.025). 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 = 0.055) and OS (104.5 vs. 152.3 months; P = 0.091) outcomes similar to those for the pCR patients. Conclusion: 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.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Jan 1 2018

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Carcinoma in Situ
Carcinoma
Drug Therapy
Muscles
Urinary Bladder Neoplasms
Disease-Free Survival
Cystectomy
Survival
Odds Ratio
Biopsy

Keywords

  • CIS
  • NAC
  • Pathologic complete response
  • Transurethral resection of bladder tumor
  • UC

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Commentary on “Prognostic effect of carcinoma in situ in muscle-invasive urothelial carcinoma patients receiving neoadjuvant chemotherapy.”. / Thomas, D. E.; Kaimakliotis, Hristos; Rice, K. R.; Pereira, J. A.; Johnston, P.; Moore, M. L.; Reed, A.; Cregar, D. M.; Franklin, C.; Loman, R. L.; Koch, Michael; Bihrle, Richard; Foster, Richard; Masterson, Timothy; Gardner, T. A.; Sundaram, Chandru; Powell, Charles; Beck, S. D.W.; Grignon, David; Cheng, L.; Albany, Costantine; Hahn, N. M.

In: Urologic Oncology: Seminars and Original Investigations, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Commentary on “Prognostic effect of carcinoma in situ in muscle-invasive urothelial carcinoma patients receiving neoadjuvant chemotherapy.”",
abstract = "Background: 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. Materials and methods: 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. Results: 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{\%} CI: 1.19–13.98; P = 0.025). 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 = 0.055) and OS (104.5 vs. 152.3 months; P = 0.091) outcomes similar to those for the pCR patients. Conclusion: 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.",
keywords = "CIS, NAC, Pathologic complete response, Transurethral resection of bladder tumor, UC",
author = "Thomas, {D. E.} and Hristos Kaimakliotis and Rice, {K. R.} and Pereira, {J. A.} and P. Johnston and Moore, {M. L.} and A. Reed and Cregar, {D. M.} and C. Franklin and Loman, {R. L.} and Michael Koch and Richard Bihrle and Richard Foster and Timothy Masterson and Gardner, {T. A.} and Chandru Sundaram and Charles Powell and Beck, {S. D.W.} and David Grignon and L. Cheng and Costantine Albany and Hahn, {N. M.}",
year = "2018",
month = "1",
day = "1",
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journal = "Urologic Oncology",
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T1 - Commentary on “Prognostic effect of carcinoma in situ in muscle-invasive urothelial carcinoma patients receiving neoadjuvant chemotherapy.”

AU - Thomas, D. E.

AU - Kaimakliotis, Hristos

AU - Rice, K. R.

AU - Pereira, J. A.

AU - Johnston, P.

AU - Moore, M. L.

AU - Reed, A.

AU - Cregar, D. M.

AU - Franklin, C.

AU - Loman, R. L.

AU - Koch, Michael

AU - Bihrle, Richard

AU - Foster, Richard

AU - Masterson, Timothy

AU - Gardner, T. A.

AU - Sundaram, Chandru

AU - Powell, Charles

AU - Beck, S. D.W.

AU - Grignon, David

AU - Cheng, L.

AU - Albany, Costantine

AU - Hahn, N. M.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: 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. Materials and methods: 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. Results: 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% CI: 1.19–13.98; P = 0.025). 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 = 0.055) and OS (104.5 vs. 152.3 months; P = 0.091) outcomes similar to those for the pCR patients. Conclusion: 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.

AB - Background: 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. Materials and methods: 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. Results: 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% CI: 1.19–13.98; P = 0.025). 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 = 0.055) and OS (104.5 vs. 152.3 months; P = 0.091) outcomes similar to those for the pCR patients. Conclusion: 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.

KW - CIS

KW - NAC

KW - Pathologic complete response

KW - Transurethral resection of bladder tumor

KW - UC

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