Tumor Site in Bladder Adenocarcinoma Predicts Survival Outcomes

Tumors in the dome or urachus confer a better prognosis than those in the lateral wall and base, study finds.
Tumors in the dome or urachus confer a better prognosis than those in the lateral wall and base, study finds.

Tumor location in patients with bladder adenocarcinoma (BAC) independently predicts survival outcomes, with tumors in the dome and urachus associated with better overall and disease-specific survival than those in the lateral wall and base, according to a new study.

A team led by Ramy F. Youssef, MD, of the University of California Irvine, retrospectively studied 1,361 BAC cases in which the tumor locations were known. They placed patients into 3 groups according to tumor location: dome and urachus (UD), lateral wall (LW), and base (trigone, ureteric orifices, and bladder neck [BL]).

The 5-year overall survival (OS) and disease-specific survival (DSS) rates were 37.3% and 49%, respectively, for all bladder cancer, Dr. Youssef and colleagues reported online ahead of print in Urologic Oncology. The 5-year OS rates were 42.3%, 35.9%, and 28.4% for UD, LW, and BL tumors, respectively. The 5-year DSS rates were 50.2%, 51.7%, and 42.1%, respectively.

In multivariable analysis controlling for tumor stage and grade, LW and BL tumors were associated with a 52% and 71% increased risk of death from any cause and a 30% and 57% increased risk of death from bladder cancer compared with UD tumors.

BAC is an uncommon variant of bladder cancer, accounting for about 0.5% to 2% of all bladder cancers in the United States, according to the investigators. Because of its rarity, the pathogenesis and natural history of BAC have not been well characterized, they noted.

The investigators stated that tumor location can stratify oncologic outcomes of patients with BAC independent of classic pathologic prognostics such as stage and grade. “Elucidation of prognostic factors, including tumor location, would aid in proper clinical decision making, permit informed patient counseling, and guide future directions in research,” the investigators wrote.

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