Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ confined urothelial carcinoma following radical nephroureterectomy

Jeffery C. Wheat, Alon Z. Weizer, J. Stuart Wolf, Yair Lotan, Mesut Remzi, Vitaly Margulis, Christopher G. Wood, Francesco Montorsi, Marco Roscigno, Eiji Kikuchi, Richard Zigeuner, Cord Langner, Christian Bolenz, Theresa M. Koppie, Jay D. Raman, Mario Fernández, Pierre Karakiewizc, Umberto Capitanio, Karim Bensalah, Jean Jacques PatardShahrokh F. Shariat

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Objective: Carcinoma in situ (CIS) is associated with increased risk of progression when found with high-grade non-muscle-invasive bladder cancer, yet its impact is less clear in the upper urinary tract. In the current study, we evaluated the impact of concomitant CIS on recurrence-free survival and cancer-specific survival following radical nephroureterectomy for upper tract urothelial carcinoma (UTUC). Materials and methods: A multi-institutional retrospective cohort of 1,387 patients undergoing radical nephroureterectomy was identified. Concomitant CIS was defined as the presence of CIS in association with another pathologic stage; patients with CIS alone were excluded from the analysis. The presence of concomitant CIS served as the exposure variable with disease recurrence and cancer-specific mortality as the outcomes. Organ-confined disease was defined as AJCC/UICC stage II or lower. Results: Concomitant CIS was identified in 371 of 1,387 (26.7%) patients and was significantly more common in patients with a previous bladder cancer history, high grade, and high stage tumors. In a multivariable analysis, concomitant CIS was a predictor of disease recurrence (HR = 1.25, . P = 0.04) and cancer specific mortality (HR = 1.34, . P = 0.05) for patients with organ-confined UTUC, but not in the entire cohort. Other prognostic variables, such as grade, stage, lymphovascular invasion, and lymph node status, were associated with poorer overall and recurrence-free survival for all patients. Conclusion: The presence of concomitant CIS in patients with organ-confined UTUC is associated with a higher risk of recurrent disease and cancer-specific mortality. This information may be useful in refining surveillance protocols and in more appropriate selection of patients for adjuvant chemotherapy.

Original languageEnglish
Pages (from-to)252-258
Number of pages7
JournalUrologic Oncology: Seminars and Original Investigations
Volume30
Issue number3
DOIs
Publication statusPublished - 2012 May

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Carcinoma in Situ
Carcinoma
Recurrence
Neoplasms
Urinary Bladder Neoplasms
Survival
Mortality
Adjuvant Chemotherapy
Urinary Tract
Patient Selection
Lymph Nodes

Keywords

  • Carcinoma in situ
  • Nephroureterectomy
  • Transitional cell carcinoma
  • Upper tract

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ confined urothelial carcinoma following radical nephroureterectomy. / Wheat, Jeffery C.; Weizer, Alon Z.; Wolf, J. Stuart; Lotan, Yair; Remzi, Mesut; Margulis, Vitaly; Wood, Christopher G.; Montorsi, Francesco; Roscigno, Marco; Kikuchi, Eiji; Zigeuner, Richard; Langner, Cord; Bolenz, Christian; Koppie, Theresa M.; Raman, Jay D.; Fernández, Mario; Karakiewizc, Pierre; Capitanio, Umberto; Bensalah, Karim; Patard, Jean Jacques; Shariat, Shahrokh F.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 30, No. 3, 05.2012, p. 252-258.

Research output: Contribution to journalArticle

Wheat, JC, Weizer, AZ, Wolf, JS, Lotan, Y, Remzi, M, Margulis, V, Wood, CG, Montorsi, F, Roscigno, M, Kikuchi, E, Zigeuner, R, Langner, C, Bolenz, C, Koppie, TM, Raman, JD, Fernández, M, Karakiewizc, P, Capitanio, U, Bensalah, K, Patard, JJ & Shariat, SF 2012, 'Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ confined urothelial carcinoma following radical nephroureterectomy', Urologic Oncology: Seminars and Original Investigations, vol. 30, no. 3, pp. 252-258. https://doi.org/10.1016/j.urolonc.2010.01.001
Wheat, Jeffery C. ; Weizer, Alon Z. ; Wolf, J. Stuart ; Lotan, Yair ; Remzi, Mesut ; Margulis, Vitaly ; Wood, Christopher G. ; Montorsi, Francesco ; Roscigno, Marco ; Kikuchi, Eiji ; Zigeuner, Richard ; Langner, Cord ; Bolenz, Christian ; Koppie, Theresa M. ; Raman, Jay D. ; Fernández, Mario ; Karakiewizc, Pierre ; Capitanio, Umberto ; Bensalah, Karim ; Patard, Jean Jacques ; Shariat, Shahrokh F. / Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ confined urothelial carcinoma following radical nephroureterectomy. In: Urologic Oncology: Seminars and Original Investigations. 2012 ; Vol. 30, No. 3. pp. 252-258.
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abstract = "Objective: Carcinoma in situ (CIS) is associated with increased risk of progression when found with high-grade non-muscle-invasive bladder cancer, yet its impact is less clear in the upper urinary tract. In the current study, we evaluated the impact of concomitant CIS on recurrence-free survival and cancer-specific survival following radical nephroureterectomy for upper tract urothelial carcinoma (UTUC). Materials and methods: A multi-institutional retrospective cohort of 1,387 patients undergoing radical nephroureterectomy was identified. Concomitant CIS was defined as the presence of CIS in association with another pathologic stage; patients with CIS alone were excluded from the analysis. The presence of concomitant CIS served as the exposure variable with disease recurrence and cancer-specific mortality as the outcomes. Organ-confined disease was defined as AJCC/UICC stage II or lower. Results: Concomitant CIS was identified in 371 of 1,387 (26.7{\%}) patients and was significantly more common in patients with a previous bladder cancer history, high grade, and high stage tumors. In a multivariable analysis, concomitant CIS was a predictor of disease recurrence (HR = 1.25, . P = 0.04) and cancer specific mortality (HR = 1.34, . P = 0.05) for patients with organ-confined UTUC, but not in the entire cohort. Other prognostic variables, such as grade, stage, lymphovascular invasion, and lymph node status, were associated with poorer overall and recurrence-free survival for all patients. Conclusion: The presence of concomitant CIS in patients with organ-confined UTUC is associated with a higher risk of recurrent disease and cancer-specific mortality. This information may be useful in refining surveillance protocols and in more appropriate selection of patients for adjuvant chemotherapy.",
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T1 - Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ confined urothelial carcinoma following radical nephroureterectomy

AU - Wheat, Jeffery C.

AU - Weizer, Alon Z.

AU - Wolf, J. Stuart

AU - Lotan, Yair

AU - Remzi, Mesut

AU - Margulis, Vitaly

AU - Wood, Christopher G.

AU - Montorsi, Francesco

AU - Roscigno, Marco

AU - Kikuchi, Eiji

AU - Zigeuner, Richard

AU - Langner, Cord

AU - Bolenz, Christian

AU - Koppie, Theresa M.

AU - Raman, Jay D.

AU - Fernández, Mario

AU - Karakiewizc, Pierre

AU - Capitanio, Umberto

AU - Bensalah, Karim

AU - Patard, Jean Jacques

AU - Shariat, Shahrokh F.

PY - 2012/5

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N2 - Objective: Carcinoma in situ (CIS) is associated with increased risk of progression when found with high-grade non-muscle-invasive bladder cancer, yet its impact is less clear in the upper urinary tract. In the current study, we evaluated the impact of concomitant CIS on recurrence-free survival and cancer-specific survival following radical nephroureterectomy for upper tract urothelial carcinoma (UTUC). Materials and methods: A multi-institutional retrospective cohort of 1,387 patients undergoing radical nephroureterectomy was identified. Concomitant CIS was defined as the presence of CIS in association with another pathologic stage; patients with CIS alone were excluded from the analysis. The presence of concomitant CIS served as the exposure variable with disease recurrence and cancer-specific mortality as the outcomes. Organ-confined disease was defined as AJCC/UICC stage II or lower. Results: Concomitant CIS was identified in 371 of 1,387 (26.7%) patients and was significantly more common in patients with a previous bladder cancer history, high grade, and high stage tumors. In a multivariable analysis, concomitant CIS was a predictor of disease recurrence (HR = 1.25, . P = 0.04) and cancer specific mortality (HR = 1.34, . P = 0.05) for patients with organ-confined UTUC, but not in the entire cohort. Other prognostic variables, such as grade, stage, lymphovascular invasion, and lymph node status, were associated with poorer overall and recurrence-free survival for all patients. Conclusion: The presence of concomitant CIS in patients with organ-confined UTUC is associated with a higher risk of recurrent disease and cancer-specific mortality. This information may be useful in refining surveillance protocols and in more appropriate selection of patients for adjuvant chemotherapy.

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KW - Nephroureterectomy

KW - Transitional cell carcinoma

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