Analysis Of Clinicopathological Features And Prognosis Of Adenocarcinoma Of Bladder In 53 Cases

ObjectiveBladder cancer is the most common tumor of the urinary system and male reproductive system in China,ranking the 7th in the incidence of male malignant tumors in China,accounting for about 2%?3%of tumor in adults.The pathology of bladder cancer can be sorted as the conventional urothelial cancer,adenocarcinoma and squamous cell carcinoma,as well as rare mixed type cancer,small cell cancer,sarcomatoid cancer,carcinosarcoma,metastasis cancer,etc.Adenocarcinoma of bladder is a rare kind of malignant tumor of the bladder,which has a high degree of malignancy,a high stage and a poor prognosis,accounting for 0.5%?2%of all malignant bladder tumors.According to the histological origin,adenocarcinoma of bladder can be divided into primary nonurachal adenocarcinoma,urachal adenocarcinoma and metastatic adenocarcinoma.Adenocarcinoma of bladder is a less common kind of bladder cancer,the prognosis of which may be related to sex,age,location,number and size of tumor,TNM stage,pathological grade,recurrence and metastasis,postoperative radiotherapy and chemotherapy,etc.We found that the analysis of clinicopathological features and prognosis of adenocarcinoma of bladder was few after searching the main databases at home and abroad,so we conduct the survival analysis through relatively large samples in a single center to explore the relationship between the above factors and prognosis,to provide more references for the diagnosis and treatment of adenocarcinoma of bladder.Subjects and methodsFrom August 2011 to January 2015,the clinicopathological data as well as the follow-up investigations of 53 cases of adenocarcinoma of bladder patients in our hospital were analyzed retrospectively,accounting for 1.6%(53/3287)of bladder tumors in the same period.39 cases were male,14 were female,male to female ratio was 2.79:1.The onset age was 28?89 years,the average onset age was 54.85±14.30 years.Our research involved the analysis of the influence of clinical characteristics,including sex,age,occupation,clinical manifestation,tumor location,tumor number,tumor size,TNM stage,pathological grade,pathological type,hydronephrosis,hypertension,diabetes and other complications,smoking and drinking history,previous benign bladder diseases,surgical approach,blood transfusion during operation,postoperative recurrence,lymph node metastasis,distant metastasis,postoperative radiotherapy,chemotherapy or perfusion/hyperthermic perfusion on survival time and prognosis.SPSS 20 statistics software was used to analysis the data,T test and Kruskal Wallis H test were applied to compare the measurement data groups.Chi-square test or Fisher exact test were used to compare the count data groups.The end point of the study was the death of the patients.Kaplan-Meier survival curve was used to estimate the survival rate,prognostic factors were assessed by the Log-rank test.Then,the factors with P<0.1 in the Log-rank test were analyzed by Cox regression model.When p<0.05,the difference was statistically significant.ResultsTumor staging was pTl in 8(15.1%),pT2 in 36(67.9%),pT3 in 6(11.3%)and pT4 in 3(5.7%).The size of lesion was 3?90mm,with median at 35.00mm.The overall follow-up rate was 71.7%.The median follow-up time was 27.3(12.0,51.5)months(ranged from 8 to 75 months).The 1-year,3-year overall survival was 82.0%(44/53),61.6%(37/53)respectively.Single factor analysis showed that sex(P=0.047),age(P=0.032),chemotherapy(P=0.041),lymph node metastasis(P=0.010),distant metastasis(P=0.023),grade(P=0.034)and profession(P<0.001)were significant prognostic factors in Log-rank test.According to the COX multivariate analysis,sex(RR=4.17,P=0.026),age(RR=6.00,P=0.015),chemotherapy(RR=10.30,P=0.005)and lymph node metastasis(RR=9.15,P=0.032)were the independent prognostic factors.ConclusionAdenocarcinoma of bladder is a rare subtype of bladder tumor,the pT2 to the pT4 cases are dominant in all cases,which may lead to the poor prognosis.Sex,age,chemotherapy and lymph node metastasis are the independent prognostic factors of adenocarcinoma of bladder according to the COX multivariate analysis.