Survival of primary adenocarcinoma of the urinary bladder after radical treatment: National Cancer Institute, 5-years’ experience

Introduction
Primary adenocarcinoma of the urinary bladder (UB) is rare but often aggressive urologic cancer. It represents 0.5–2% of all bladder cancers and affects patients mostly in their sixth decade of life. The incidence is greater in areas where bilharziasis is endemic and is more common in men than women.
Aim of the work
The aim of the study was to review this rare UB malignancy with special emphasis on patients’ survival including; disease-free survival (DFS) and overall survival (OS) in relation to different clinical and pathological factors.
Patients and methods
We conducted this retrospective review of 40 patients with primary UB adenocarcinoma who were treated and followed up in the National Cancer Institute, Cairo University between January 2013 and December 2017.
Results
The study included 40 patients with a male to female ratio of 82.5 : 17.5%. The mean age at diagnosis was 61 years. Hematuria was the most common presenting symptom followed by dysuria and frequency. Pathologically, stage III disease, tumor grade II, and adenocarcinoma, not otherwise specified, were the most common findings. Radical cystectomy was done in 82.5% of cases, while anterior pelvic exenteration was done in 17.55% of cases followed in both by different methods of urinary diversions. The median follow-up was 31 months, and the 2-year DFS of all patients was 60.7%. Two-year DFS was significantly affected by tumor grade, disease stage, and lymph node (LN) status (=0.019, 0.021, 0.001, respectively). Furthermore, 3-year OS of all groups was 57% with a median follow-up of 39.9 month. Tumor grade, disease stage, and LN involvement had an impact on OS. However, the only statistically significant effect is due to LN involvement (=0.037).
Conclusion
Patients with UB adenocarcinoma commonly present in an advanced disease. DFS and OS are affected by disease stage, tumor grade, and LN involvement. We recommend radical rather than any form of conservative surgery as a primary treatment modality.