Diagnosis and management of urothelial carcinoma in situ of the lower urinary tract: a systematic review

Rowan G Casey; James W F Catto; Liang Cheng; Michael S Cookson; Harry Herr; Sharokh Shariat; J Alfred Witjes; Peter C Black

doi:10.1016/j.eururo.2014.10.040

Diagnosis and management of urothelial carcinoma in situ of the lower urinary tract: a systematic review

Eur Urol. 2015 May;67(5):876-88. doi: 10.1016/j.eururo.2014.10.040. Epub 2014 Nov 14.

Authors

Rowan G Casey¹, James W F Catto², Liang Cheng³, Michael S Cookson⁴, Harry Herr⁵, Sharokh Shariat⁶, J Alfred Witjes⁷, Peter C Black⁸

Affiliations

¹ Department of Urology, Essex Cancer Centre, Colchester General Hospital, Colchester, UK.
² Academic Urology Unit, University of Sheffield, Sheffield, UK.
³ Departments of Pathology and Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
⁴ Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
⁵ Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
⁶ Department of Urology, Medical University of Vienna and Weill Cornell Medical College, New York, NY, USA.
⁷ Department of Oncological Urology, University Hospital Nijmegen, Nijmegen, The Netherlands.
⁸ Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: pblack@mail.ubc.ca.

PMID: 25466937
DOI: 10.1016/j.eururo.2014.10.040

Abstract

Context: Urothelial carcinoma in situ (CIS) has a high propensity for progression. It is usually reported within the heterogeneous context of non-muscle-invasive bladder cancer (NMIBC) but warrants special consideration.

Objective: To review the contemporary literature on the diagnosis and management of CIS.

Evidence acquisition: A systematic search using broad terms to capture the diagnosis and treatment of CIS was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria. Full-text original articles, reviews, and editorials from 1966 to 2014 in English were included. References from selected articles, relevant guidelines, and conference abstracts were searched. Abstracts were excluded.

Evidence synthesis: A total of 1887 articles were identified, of which 120 were used in this review. Most reports were retrospective and heterogeneous in caseload. There is a lack of standardised classification of CIS. Many studies consider CIS in the context of NMIBC without a clear separation of the subset with CIS. Recent prospective phase 2 and 3 studies have improved the evidence base.

Conclusions: We are beginning to understand that CIS has a spectrum of biologic potential. Bacillus Calmette-Guérin immunotherapy appears superior to other intravesical agents and may alter the natural history of CIS. New imaging modalities, agents, and treatment strategies have emerged in recent years with the aim of better identification of CIS, more bladder-preserving treatments, and prevention of surgical overtreatment.

Patient summary: Improvements in imaging techniques combined with new bladder-preserving treatments will continue to have an impact on the outcomes of bladder carcinoma in situ.

Keywords: Bacillus Calmette-Guérin; Bladder; Fluorescent cystoscopy; Gemcitabine; Hyperthermia; Interferon-α; Intravesical immunotherapy; Narrow-band cystoscopy; Photodynamic diagnosis; Urothelial carcinoma in situ; Valrubicin.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Adjuvants, Immunologic / therapeutic use*
Administration, Intravesical
Carcinoma in Situ / diagnosis
Carcinoma in Situ / therapy*
Carcinoma, Transitional Cell / diagnosis
Carcinoma, Transitional Cell / therapy*
Humans
Multimodal Imaging
Treatment Outcome
Urinary Tract / drug effects
Urinary Tract / pathology*
Urologic Neoplasms / diagnosis*
Urologic Neoplasms / pathology
Urologic Neoplasms / therapy*

Substances

Adjuvants, Immunologic