The clinical impact of the classification of carcinoma in situ on tumor recurrence and their clinical course in patients with bladder tumor

Objective: To evaluate recurrence and clinical course of bladder carcinoma in situ according to the current carcinoma in situ classification by analyzing the patients with diagnosed carcinoma in situ in our hospital. Methods: Between January 1993 and September 2008, 93 patients were initially diagnosed with bladder carcinoma in situ in our hospital. All specimens underwent an additional review by one uro-pathologist. Primary, secondary and concurrent carcinoma in situ were found in 26, 21 and 46 patients, respectively. Sixty-nine patients (74.2%) underwent bacillus Calmette-Guérin instillation therapy. Results: The multivariate analysis determined that the secondary carcinoma in situ and the absence of bacillus Calmette-Guérin therapy were the independent unfavorable risk factors for tumor recurrence. The 5-year recurrence-free survival rates on primary, concurrent and secondary carcinoma in situ were 60.9, 63.2 and 25.4%, respectively, and the differences between secondary and primary carcinoma in situ, and secondary and concurrent were significant (P= 0.023 and P= 0.006, respectively). During the median follow-up period of 47 months, 19 patients had tumor recurrence in the bladder after the first bacillus Calmette-Guérin therapy, and 13 of them were treated with a second bacillus Calmette-Guérin therapy. After the second bacillus Calmette-Guérin therapy six patients eventually had distant metastasis and three had upper tract recurrence, whereas totally four had a tumor-free status after the second bacillus Calmette-Guérin therapy. Conclusions: The first induction course of bacillus Calmette-Guérin therapy proved to be effective for the prevention of bladder cancer recurrence, however, the efficacy of a second bacillus Calmette-Guérin therapy on a recurrent tumor was somewhat limited.