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Pathological characteristics and prognostic indicators of different histopathological types of urinary bladder cancer following radical cystectomy in a large single-center Egyptian cohort

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Abstract

Objective

To evaluate differences in pathological features and prognostics across four bladder cancer histopathological types: urothelial carcinoma (UC), urothelial carcinoma with variant histology (UCV), squamous cell carcinoma (SCC) and adenocarcinoma (ADC), utilizing a large cohort of radical cystectomy (RC) patients.

Methods

A retrospective analysis of patients who underwent RC at a single institution in Egypt between 1997 and 2004 was performed. Kaplan–Meier and multivariable analyses were performed to evaluate the prognostic significance of pathological features including tumor stage, grade, lymphovascular invasion (LVI), and lymph node (LN) involvement in the different subtypes on disease-free survival (DFS).

Results

1238 patients (975 male, 263 female) were included, of whom 577 (47%) had UC, 174 (14%) UCV, 398 (32%) SCC, and 89 (7%) ADC. Median age was 54 (20–87) years and median follow-up was 40 months (0–110). There were significant differences in stage, grade, LVI, LN involvement, and presence of schistosomiasis across the subtypes (all p < 0.05). The prognostic significance of LVI was more evident in SCC (HR 2.14, p = 0.003) and ADC (HR 2.17, p = 0.044) than in UC (HR 1.66, p = 0.008). LN involvement was the strongest prognostic factor in UCV (HR 2.14, p = 0.012).

Conclusions

There are significant differences in clinicopathological features and their prognostic impact across bladder cancer subtypes. The prognostic significance of LVI is more evident in SCC and ADC, while LN involvement is more prognostic in UCV. Determining independent predictors in individual subtypes can guide multimodal treatment selection and clinical trial design.

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Abbreviations

UC:

Urothelial carcinoma

UCV:

Urothelial carcinoma with variant histology

SCC:

Squamous cell carcinoma

ADC:

Adenocarcinoma

RC:

Radical cystectomy

DFS:

Disease-free survival

LVI:

Lymphovascular invasion

LN:

Lymph node

SEER:

Surveillance, epidemiology, and end results

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Author information

Authors and Affiliations

  1. Department of Urology, University of California, Irvine, Orange, CA, USA

    Jeremy W. Martin, Simone L. Vernez, Ahmed Abdelhalim, Rahul Dutta & Ramy F. Youssef

  2. Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA

    Yair Lotan

  3. Department of Urology, Urology and Nephrology Center, Mansoura, Egypt

    Ahmed Abdelhalim, Ahmed Shokeir, Hassan Abol-Enein, Ahmed Mosbah & Mohamed Ghoneim

Authors
  1. Jeremy W. Martin
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  2. Simone L. Vernez
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  3. Yair Lotan
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  4. Ahmed Abdelhalim
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  5. Rahul Dutta
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  6. Ahmed Shokeir
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  7. Hassan Abol-Enein
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  8. Ahmed Mosbah
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  9. Mohamed Ghoneim
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  10. Ramy F. Youssef
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Contributions

JWM: data analysis and manuscript writing/editing. SLV: data analysis and manuscript writing/editing. YL: manuscript writing/editing. AA: manuscript writing/editing. RD: manuscript writing/editing. AS: protocol/project development, data collection, or management. HA-E: protocol/project development, data collection, or management. AM: protocol/project development, data collection, or management. MG: protocol/project development, data collection or management. RFY: protocol/project development, data collection or management, data analysis, and manuscript writing/editing.

Corresponding author

Correspondence to Ramy F. Youssef.

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The authors declare that they have no conflict of interest.

Human and/or animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Martin, J.W., Vernez, S.L., Lotan, Y. et al. Pathological characteristics and prognostic indicators of different histopathological types of urinary bladder cancer following radical cystectomy in a large single-center Egyptian cohort. World J Urol 36, 1835–1843 (2018). https://doi.org/10.1007/s00345-018-2331-6

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  • DOI: https://doi.org/10.1007/s00345-018-2331-6

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