Adenocarcinoma Versus Urothelial Carcinoma of the Urinary Bladder: Comparison Between Pathologic Stage at Radical Cystectomy and Cancer-specific Mortality

Lughezzani, Giovanni; Sun, Maxine; Jeldres, Claudio; Alasker, Ahmed; Budäus, Lars; Shariat, Shahrokh F.; Latour, Mathieu; Widmer, Hugues; Duclos, Alain; Jolivet-Tremblay, Martine; Montorsi, Francesco; Perrotte, Paul; Karakiewicz, Pierre I.

doi:10.1016/j.urology.2009.10.018

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Volume 75, Issue 2 , Pages 376-381, February 2010

Adenocarcinoma Versus Urothelial Carcinoma of the Urinary Bladder: Comparison Between Pathologic Stage at Radical Cystectomy and Cancer-specific Mortality

Giovanni Lughezzani
- Cancer Prognosis and Health Outcomes Unit, University of Montréal Health Center, Montreal, Quebec, Canada
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
Maxine Sun
- Cancer Prognosis and Health Outcomes Unit, University of Montréal Health Center, Montreal, Quebec, Canada
Claudio Jeldres
- Cancer Prognosis and Health Outcomes Unit, University of Montréal Health Center, Montreal, Quebec, Canada
Ahmed Alasker
- Cancer Prognosis and Health Outcomes Unit, University of Montréal Health Center, Montreal, Quebec, Canada
Lars Budäus
- Cancer Prognosis and Health Outcomes Unit, University of Montréal Health Center, Montreal, Quebec, Canada
Shahrokh F. Shariat
- Cancer Prognosis and Health Outcomes Unit, University of Montréal Health Center, Montreal, Quebec, Canada
Mathieu Latour
- Department of Pathology, University of Montréal, Montreal, Quebec, Canada
Hugues Widmer
- Department of Urology, University of Montréal, Montreal, Quebec, Canada
Alain Duclos
- Department of Urology, University of Montréal, Montreal, Quebec, Canada
Martine Jolivet-Tremblay
- Department of Urology, University of Montréal, Montreal, Quebec, Canada
Francesco Montorsi
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
Paul Perrotte
- Department of Urology, University of Montréal, Montreal, Quebec, Canada
Pierre I. Karakiewicz
- Cancer Prognosis and Health Outcomes Unit, University of Montréal Health Center, Montreal, Quebec, Canada
- Department of Urology, University of Montréal, Montreal, Quebec, Canada
- Reprint requests: Pierre I. Karakiewicz, M.D., F.R.C.S.C., Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center (CHUM), 1058, Rue St.-Denis, Montréal, QC, Canada, H2X 3J4

Received 14 September 2009; accepted 15 October 2009. published online 17 December 2009.

Objectives

To compare stage at radical cystectomy (RC) and cancer-specific mortality (CSM) after RC between non-urachal adenocarcinoma (ADK) and urothelial carcinoma (UC) of the urinary bladder.

Methods

Within 17 Surveillance, Epidemiology and End Results registries, we identified ADK and UC patients who underwent a RC between 1988 and 2006. We examined differences in stage and grade at RC between ADK and UC patients. Kaplan–Meier plots depicted CSM after RC. Cox regression analyses examined CSM rates, adjusted for T and N stages, tumor grade, age, gender, race, and year of surgery. Thereafter, we relied on statistically significant variables from the multivariate Cox regression model to match ADK and UC patients. Finally, we plotted Kaplan–Meier survival curves of the matched ADK and UC patients.

Results

Of 306 ADK and 11 697 UC patients, 188 (61.4%) and 5538 (47.3%), respectively, showed extravesical disease (pT_3-4; P <.001) and 26.5% vs 21.7% had lymph node metastases at RC (P = .04), respectively. After adjustment for all covariates, including stage and grade, ADK was not associated with worse prognosis than UC (hazard ratio, 1.05; P = .6). Similarly, after matching, no difference in CSM was recorded between the 2 histologic subtypes (hazard ratio, 1.07; P = .5).

Conclusions

ADK patients undergo RC at more advanced disease stages. However, stage- and grade-adjusted CSM is the same between ADK and UC patients. Efforts should be aimed at providing definitive treatment at earlier stages, especially in patients with ADK histologic subtype.