Primary adenocarcinoma of the urinary bladder : risk factors and value of postoperative radiotherapy

Abstract EN

Objective : to evaluate the clinical presentation and treatment outcome of primary adenocarcinoma of the urinary bladder, to determine the significant prognostic factors and to evaluate the value of postoperative radiotherapy as an adjuvant treatment.

Patients and methods : Out of 2787 cystectomies patients, 142 had adenocarcinoma of the urinary bladder with a relative frequency of 5.1 %.

Most of these patients (67.6 %) presented in late stages (P3 + P4, UICC 1997).

The incidence of pelvic lymph nodes involvement was 23.2 %.

Mucinous adenocarcinoma was reported in 21 patients (14.8 %), papillary in 16 patients (11.3 %), signet ring in 10 patients (7 %), while not otherwise specified (NOS) was reported in 95 patients (66.9 %) in the cystec-tomy specimens.

Results : Mucinous and signet-ring histological subtypes showed increased frequency of high stages and high grades and more nodal involvement than the papillary and NOS.

All patients were treated with radical cystectomy and pelvic lymphadenectomy with (46 patients) or without (96 patients) postoperative radiotherapy (PORT).

The 5-year disease-free survival (DFS) rate was 46.6±5.0% for all adenocarcinoma patients.

Postoperative radiotherapy improved the DFS, though it did not reach to the level of significance (p = 0.06).

The 5-year DFS rate for PORT group was 56.7 ± 7.5 % compared to 38.2 ± 6.1 % for cystectomy alone group.

The difference was more apparent (p = 0.01) when we compared patients whom PORT was indicated (P2b, P3, P4a) as cystectomy alone in such patients attained 24.2 ± 9.0 % 5-year DFS rate.

PORT improved local recurrence significantly as the 5-year local control rate dropped markedly from 97±2.8% for PORT to 55.9±7.4% for cystectomy alone patients.

Distant metastases were the leading cause of death in PORT group probably due to the short survival after local recurrence.

Conclusion : within the limitations provided by retrospective studies, we can conclude that PORT improved the DFS through its effect on local control.

The DFS independent prognostic variables were : tumor stage, PORT, nodal involvement and adenocarcinoma sub classification.