Long term oncologic outcome in patients with bladder cancer after radical cystectomy: Impact of carcinoma in situ in the era of neoadjuvant chemotherapy

  • Erfan Amini
  • Nariman Ahmadi
  • Thomas G. Clifford
  • Cory M. Hugen
  • Soroush T. Bazargani
  • Jie Cai
  • Gus Miranda
  • Andy E. Sherrod
  • Siamak Daneshmand
  • Hooman DjaladatEmail author
Urology - Original Paper



To assess the impact of carcinoma in situ (CIS) on oncologic outcomes in patients who underwent radical cystectomy, with a focus on those who received neoadjuvant chemotherapy (NAC) including patients with down-staging to ≤ pT1cancer after chemotherapy.

Materials and methods

All patients who underwent radical cystectomy for urothelial cancer with curative intent from 1985 to 2011 were included. The impact of CIS on recurrence free and overall survival (OS) was assessed in the whole cohort and a subgroup who received NAC as well as those with response to chemotherapy and down-staging to ≤ pT1.


A total of 2518 patients with a median follow-up period of 9 years were included. Among all, 1397 (55.5%) had concomitant CIS on final pathology. CIS was associated with high risk pathologic features including high-grade disease, multifocality, and nodal involvement as well as worse recurrence free survival (RFS) with no impact on OS. We did not find a significant association between CIS and oncologic outcomes in a subset of patients who received NAC including those with down-staging to ≤ pT1 disease. In multivariate analysis, CIS had no association with either recurrence free or OS.


Concomitant CIS in radical cystectomy specimens is associated with decreased RFS; however, in multivariate analysis, it was not an independent predicting factor of oncologic outcomes. Moreover, the impact of CIS on oncologic outcomes in a subset of patients who received NAC was insignificant.


Carcinoma in situ Cystectomy Neoadjuvant therapy Survival Urinary bladder neoplasms 


Compliance with ethical standards

Conflict of interest

All authors declare no conflicts of interests.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the Helsinki declaration.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Erfan Amini
    • 1
    • 2
  • Nariman Ahmadi
    • 1
  • Thomas G. Clifford
    • 1
  • Cory M. Hugen
    • 1
  • Soroush T. Bazargani
    • 1
  • Jie Cai
    • 1
  • Gus Miranda
    • 1
  • Andy E. Sherrod
    • 3
  • Siamak Daneshmand
    • 1
  • Hooman Djaladat
    • 1
    • 4
    Email author
  1. 1.Institute of Urology, Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Department of Urology, Uro-Oncology Research CenterTehran University of Medical SciencesTehranIran
  3. 3.Department of Pathology, Norris Comprehensive Cancer Center, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  4. 4.Institute of Urology, USC/Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesUSA

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