Mp71-09 Does Multifocal Carcinoma-in-Situ Impact the Risk of Tumor Progression in Non-Muscle Invasive Bladder Cancer Patients?

You have accessJournal of UrologyBladder Cancer: Non-invasive IV (MP71)1 May 2024MP71-09 DOES MULTIFOCAL CARCINOMA-IN-SITU IMPACT THE RISK OF TUMOR PROGRESSION IN NON-MUSCLE INVASIVE BLADDER CANCER PATIENTS? Jethro C. C. Kwong, Zizo Al-Daqqaq, Yashan Chelliahpillai, Soomin Lee, Kellie Kim, Maximiliano Ringa, Amna Ali, Marian S. Wettstein, Amy Chan, Nathan Perlis, Jason Y. Lee, Robert J. Hamilton, Neil E. Fleshner, Antonio Finelli, Andrew Feifer, Girish S. Kulkarni, and Alexandre R. Zlotta Jethro C. C. KwongJethro C. C. Kwong , Zizo Al-DaqqaqZizo Al-Daqqaq , Yashan ChelliahpillaiYashan Chelliahpillai , Soomin LeeSoomin Lee , Kellie KimKellie Kim , Maximiliano RingaMaximiliano Ringa , Amna AliAmna Ali , Marian S. WettsteinMarian S. Wettstein , Amy ChanAmy Chan , Nathan PerlisNathan Perlis , Jason Y. LeeJason Y. Lee , Robert J. HamiltonRobert J. Hamilton , Neil E. FleshnerNeil E. Fleshner , Antonio FinelliAntonio Finelli , Andrew FeiferAndrew Feifer , Girish S. KulkarniGirish S. Kulkarni , and Alexandre R. ZlottaAlexandre R. Zlotta View All Author Informationhttps://doi.org/10.1097/01.JU.0001009548.76580.ba.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Concomitant carcinoma-in-situ (CIS) is an established prognosticator of progression in non-muscle invasive bladder cancer (NMIBC). However, current risk calculators do not distinguish between unifocal vs multifocal CIS. We aimed to assess whether CIS distribution would further impact progression risk. METHODS: In this multi-institutional retrospective cohort study, clinicopathological data were collected for Ta/T1 NMIBC patients treated between 2005-2022. Patients received intravesical bacillus Calmette-Guérin when indicated. Unifocal CIS was defined as presence of CIS in only one tumor specimen (ie. papillary disease with CIS at the tumor base, or papillary disease with isolated CIS in only one specimen). Multifocal CIS was defined as presence of CIS in more than one specimen. Progression was defined as development of muscle-invasive or metastatic disease. Multivariable Cox regression was performed to identify adverse prognostic factors for progression. RESULTS: A total of 2,924 patients were included, of which 384 (13%) progressed during a median follow-up of 4.8 years (IQR 2.6-8.0). Median age was 71 years (IQR 62-79) and 697 (24%) patients were female. 943 (32%) patients had T1 disease, 1,488 (51%) had high grade, and 328 (11%) had concomitant CIS, of which 234 (8%) and 94 (3%) had unifocal and multifocal CIS, respectively. On multivariable analyses, older age, T1 stage, high grade, multifocal CIS (but not unifocal), and multiple tumors were associated with increased risk of progression (Table 1). In a subset analysis of patients with concomitant CIS (n=328), multifocal CIS remained an adverse prognostic factor (HR 2.0, 95% CI 1.2-3.2, p=0.006) after controlling for age, stage, grade, number of tumors, and tumor diameter. CONCLUSIONS: Not all CIS carry the same risk of progression in NMIBC. Multifocal CIS is an important prognostic factor for progression in Ta/T1 NMIBC. Distinguishing between unifocal vs multifocal CIS should be encouraged and our results should be validated in independent cohorts. These findings stress the importance of sending separate tumor specimens to pathology at the time of transurethral resection of bladder tumor for accurate bladder tumor mapping and to distinguish between unifocal vs multifocal CIS. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1163 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jethro C. C. Kwong More articles by this author Zizo Al-Daqqaq More articles by this author Yashan Chelliahpillai More articles by this author Soomin Lee More articles by this author Kellie Kim More articles by this author Maximiliano Ringa More articles by this author Amna Ali More articles by this author Marian S. Wettstein More articles by this author Amy Chan More articles by this author Nathan Perlis More articles by this author Jason Y. Lee More articles by this author Robert J. Hamilton More articles by this author Neil E. Fleshner More articles by this author Antonio Finelli More articles by this author Andrew Feifer More articles by this author Girish S. Kulkarni More articles by this author Alexandre R. Zlotta More articles by this author Expand All Advertisement PDF downloadLoading ...