ABSTRACT
Objective:
To explore the clinicopathological characteristics and
prognostic factors of
bladder squamous cell carcinoma (SqCC)and
bladder adenocarcinoma.
Methods:
A retrospective
analysis of the clinical data of 107
patients with nonurothelial
carcinoma of the
bladder admitted to the First Affiliated
Hospital of Zhengzhou
University from October 2011 to January 2019 was performed. Among the 107
patients, 78 were
males and 29 were
females(ratio 2.69∶1), and the median
age of onset was 62.0 years. According to histological types,
patients were divided into SqCC group, urachal
adenocarcinoma group and non-urachal
adenocarcinoma group. There were 55 cases in the SqCC group, including 40
males and 15
females. Their mean age was 69.0(58.0, 75.0) years. 14 cases had the
history of
smoking. The clinic manifestation included
hematuria in 35 cases,
bladder irritation in 13 cases,
dysuria in 2 cases and
pain in 5 cases .
Tumors located at the anterior and posterior walls in 18 cases, at the lateral wall in 27 cases, at the triangular area in 8 cases and at the apical wall in 2 cases. The average diameter of
tumor was 4.5(3.0, 6.0) cm. 37 cases suffered with single
tumor and 18 cases suffered with multiple
tumors. The surgical
method was
radical cystectomy in 38 cases,
partial cystectomy in 4 cases, TURBT in 9 cases, interventional
surgery in 2 cases, and no operation in 2 cases. There were 20 cases in the urachal
adenocarcinoma group, including 14
males and 6
females; age 53.5(43.5, 57.8) years; 6 cases with a
history of
smoking. The clinic manifestation included
hematuria in 16 cases,
bladder irritation in 1 case,
pain in 2 cases and asymptomatic in 1 case.
Tumors located at anterior and posterior walls in 4 cases and at apical wall in 16. The average diameter of
tumor was 3.0(2.0, 4.8) cm. Single
tumor was present in 18 cases, multiple
tumors were present in 2 cases. The surgical
method was
partial cystectomy in 16 cases,
radical cystectomy in 1 case, TURBT in 1 case and no operation in 2 cases. There were 32 cases in the non-urachal
adenocarcinoma group, including 24
males and 8
females. Their mean age was 55.0(46.3, 70.8) years.11 cases had a
history of
smoking. The clinic manifestation included
hematuria in 16 cases,
bladder irritation in 3 cases,
dysuria in one case and
pain in 7 cases.
Tumor located at anterior and posterior walls in 17 cases, at lateral wall in 7 cases, at triangular area in 5 cases and at apical wall in 3 cases. The average diameter of
tumor was 3.6(2.0, 4.5) cm. 23 cases suffered with single
tumor, 9 cases suffered with multiple
tumors.The surgical
method was
radical cystectomy in 11 cases,
partial cystectomy in 9 cases, TURBT in 9 cases , and no operation in 3 cases. The preoperative data of the three groups of
tissue types were compared, the differences of
age of onset,
tumor diameter,
tumor location, reason for
treatment, operation
method ( P<0.05)among the 3 groups were statistically significant. The clinicopathological characteristics and
prognosis of the 3 groups of
tissue types were compared, and the Cox proportional regression
risk model was used to analyze the clinical factors affecting the
prognosis.
Results:
91
patients were followed up, the overall follow-up rate was 85.1%, the median follow-up
time was 26(7, 48) months. The 3-year and 5-year overall
survival rates were 54.1% and 42.2%, respectively. In the SqCC group, 11 cases received
chemotherapy; 3 cases received postoperative
radiotherapy; 12 cases received postoperative
perfusion.10 cases had
recurrence; 17 cases had
lymph node metastasis; 19 cases had distant
metastasis; 5 cases were pT x in pT stage, 36 cases were pT 1-pT 2, 14 cases were pT 3-pT 4. 19 cases had unknown
tumor differentiation, 4 cases had well differentiated, 24 cases had moderately differentiated and 8 cases had poorly differentiated. In the urachal
adenocarcinoma group, 7 cases received
chemotherapy, 3 cases had
recurrence, 2 cases had
lymph node metastasis, 2 cases had distant
metastasis; 1 case was pT x in pT stage, 16 cases were pT 1-pT 2, 3 cases were pT 3-pT 4. 9 cases had unknown
tumor differentiation, 3 cases had well differentiated, and 5 cases had moderately differentiated, 3 cases had poorly differentiated. In the urachal
adenocarcinoma group, 3 cases received
chemotherapy, 1 case received postradiotherapy, 11 cases received postoperative
perfusion; 10 cases had
recurrence. 5 cases had
lymph node metastasis, 4 cases had distant
metastasis, 6 cases were pT x, 21 cases were pT 1-pT 2 and 5 cases were pT 3-pT 4. 14 cases had unknown
tumor differentiation, 8 cases had moderately differentiated and 10 cases had poorly differentiated.The postoperative general data of the three groups of
tissue types were compared. There was statistically significant difference between whether there was postoperative
perfusion and whether there was distant
metastasis (all P<0.05). The univariate
analysis results showed
gender, age, surgical
method,
lymph node metastasis, distant
metastasis, pT
staging, tumor differentiation and histological type were
risk factors that
affect the
prognosis(all P<0.05). Cox
multivariate analysis showed that
women ( HR=2.604, P=0.032) and distant
metastases ( HR=2.571, P=0.026) were independent
risk factors affecting the
prognosis of
patients.
Conclusions:
SqCC and
adenocarcinoma are clinically rare and have poor
prognosis. They often present with
hematuria. Surgical
treatment is the first choice.
Radical cystectomy is the first choice for SqCC and non-urachal
adenocarcinoma, and extended
partial cystectomy is the first choice for urachal
adenocarcinoma.
Female and distant
metastasis are independent
risk factors affecting the
prognosis of
patients.