TITLE:
Primary Bladder Adenocarcinoma: A Five-Year Retrospective Clinicopathologic Study of 42 Cases in Egyptian NCI (2010-14)
AUTHORS:
Yahia Ismail, Amr Kamal, Osama Yousof, Neveen Tahoun, Rasha Allam
KEYWORDS:
Bladder Cancer, Primary, Adenocarcinoma, Bilharziasis, NCI, Egypt
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.10 No.1,
January
23,
2019
ABSTRACT: 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
was linked significantly with longer OS (p =
0.007, 0.037 & 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.