Cytogenetic studies of carcinoma in situ of the bladder: prognostic implications

Carcinoma in situ of the bladder has traditionally been considered a lethal disease by most urologists and as such it has been treated most frequently in an aggressive manner. Recent investigations have suggested that carcinoma in situ of the bladder may, in fact, be a complex of diseases that exists in at least 2 distinct disease forms, 1 aggressive and 1 relatively nonaggressive. We studied the cytogenetics of 17 patients diagnosed clinically and pathologically to have carcinoma in situ, and found a positive correlation of karyotype complexity (numerical and structural changes) with disease course. Superficial tumors with normal karyotypes remained superficial throughout the study and continued to exhibit a nonaggressive course, while patients whose tumors had an abnormal karyotype at diagnosis expressed a much more aggressive course that ultimately developed into invasive disease. Nonrandom chromosomal changes involving chromosomes 1, 5, 8 and 11 were observed in these tumors. Therefore, cytogenetic evaluation may prove to be an important guide in helping to determine an appropriate treatment course for patients with carcinoma in situ of the bladder.