Primary Bladder Adenocarcinoma: A Five-Year Retrospective Clinicopathologic Study of 42 Cases in Egyptian NCI (2010-14)

摘要

Aim : Globally, primary adenocarcinoma (AC) accounts for only 0.5% - 2% of bladder cancer (BC). Bilharziasis predisposes to AC in ~10% of BC in endemic regions. The aim was to study the clinicopathologic characteristics of this rare entity and define prognostic elements influencing disease-free (DFS) & overall survival (OS). Patients & Methods : A retrospective analysis of 42 cases of primary bladder AC presented to the National Cancer Institute of Egypt (NCI-E) during a five-year period (2010-2014), clinicopathologic profiles, management and survival were assessed. Results : The mean age was 55.5 years ± 9.77 with male predominance. Hematuria, bilharziasis & urachal type experienced in 88%, 35.7% & 4.8%, respectively. Radical surgery was employed in 64.3%. Metastatic disease (stageIVB) found in 14.3%, initially. Eleven patients (26.2%) received palliative chemotherapy for their advanced or metastatic disease, objective response rates (ORR) were 0% & 100% for those received gemcitabine/platinum & capecitabine/oxaliplatin, respectively. The 5-year DFS & OS rates were 40.7 % & 27%, respectively. DFS was significantly enhanced in patients having GII, negative nodes (pN0) and absence of hydronephrosis ( p = 0.001, 0.011 & 0.047, respectively). Presentation with hematuria, pN0 & stage II w as linked significantly with longer OS ( p = 0.007, 0.037 & < 0.001, respectively). Tumour grade & clinical stage were inde pendent prognostic factors affecting DFS & OS, respectively on multivariate analysis . Conclusions : Notable reduction in incidence of bladder AC in Egypt is mostly due to decline in bilharzial infection. Tumor grade & clinical stage are independent prognostic factors for DFS & OS, respectively. Still no agreement about the role of adjuvant radiotherapy or chemotherapy, however, protocols employed for colorectal cancer seem to be profitable in advanced and metastatic cases. Further larger scale studies are needed to define the hazard factors, molecular characterises and optimal management of this rare type of BC.