Prognostic value of concomitant carcinoma in situ in the radical cystectomy specimen: A systematic review and meta-analysis.

PURPOSE: To investigate the prognostic impact of concomitant carcinoma in situ (CIS) in radical cystectomy (RC) specimens.

MATERIALS AND METHODS: A systematic review and meta-analysis was performed using the MEDLINE, SCOPUS, Web of Science and Cochrane Library in 10th October 2017 to identify the eligible studies published until October 2017. Studies were eligible if they compared patients with concomitant CIS in RC specimens for bladder cancer (BC) to patients without concomitant CIS to determine its value for prognosticating overall mortality (OM), recurrence free survival (RFS), cancer specific mortality (CSM) and ureter involvement using multivariable analysis. The protocol for this systematic review was registered on PROSPERO (Central Registration Depository: CRD42018086539) and is available in full on the University of York website.

RESULTS: Overall, 23 studies published between 2006 and 2017 including 20,647 patients were selected for the systematic review and meta-analysis. Concomitant CIS was reported in 39.4% of RC specimens. In studies analyzing all patients, the presence of concomitant CIS was not associated with OM (pooled HR, 0.92; 0.77-1.10), RFS (pooled HR, 1.06; 0.99-1.13) and CSM (pooled HR, 1.00; 0.93-1.07), but with ureter involvement (pooled OR, 4.51; 2.59-7.84). In a sub-analysis of studies restricted to patients with organ-confined BC at time of RC, concomitant CIS was associated with both worse RFS (pooled HR, 1.57; 1.12-2.21) and CSM (pooled HR, 1.51; 1.001-2.280).

CONCLUSIONS: Concomitant CIS is significantly associated with ureter involvement in patients treated with RC. In patients with organ-confined disease, concomitant CIS in RC specimen is a prognosticator of both RFS and CSM.