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Invasive non-urachal adenocarcinoma of the bladder: analysis of the National Cancer Database

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Abstract

Purpose

To review the United States National Cancer Database (NCDB) from 2004 to 2015 and analyze survival outcomes of invasive non-urachal adenocarcinoma based on treatment modality.

Methods

The NCDB 2004–2015 bladder dataset was queried for adenocarcinoma histology, excluding urachal variant, and limited to patients with clinical stage T2–T4 disease. Treatment modality was categorized as no treatment, cystectomy (partial or radical), external beam radiation therapy (EBRT), or EBRT plus cystectomy. Our primary outcome was overall survival. Cox regression (CR) and Kaplan–Meier (KM) analysis were performed.

Results

851 patients were identified with invasive (cT2–T4) adenocarcinoma of the bladder. Treatment modalities included 398 (47.8%) no treatment, 298 (35.8%) cystectomy, 124 (14.9%) EBRT, and 31 (3.7%) EBRT plus cystectomy. On KM analysis excluding those with metastatic disease, the 5-year survival was significantly better (p < 0.001) for patients who underwent cystectomy (39.6%), versus no treatment (21.0%), EBRT (18.6%), or EBRT plus cystectomy (26.9%) (log rank, p < 0.001). On CR for mortality, age (HR 1.030, p < 0.001), Charlson score 1 (HR 1.287, p = 0.034), cT4 (HR 1.768, p < 0.001), and receiving treatment at a low-volume center (HR 1.289, p = 0.026) were associated with worsened survival; however, cystectomy (HR 0.593, p < 0.001) was the only factor associated with improved survival. For those undergoing cystectomy, the mean length of stay was 8.5 days and the 30-day readmission rate was 7.0%.

Conclusions

Invasive non-urachal adenocarcinoma of the bladder is a rare diagnosis. Survival benefits in patients without metastatic disease are seen only in those patients undergoing definitive surgery.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA

    Facundo Davaro, Jared Schaefer, Allison May, Johar Raza, Sameer Siddiqui & Zachary Hamilton

Authors
  1. Facundo Davaro
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  2. Jared Schaefer
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  3. Allison May
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  4. Johar Raza
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  5. Sameer Siddiqui
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  6. Zachary Hamilton
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Contributions

Authors whose names appear on the submission have contributed sufficiently to the scientific work and therefore share collective responsibility and accountability for the results. FD: project development, data management, manuscript writing. JS: project development. AM: project development. JR: project development. SS: project development, manuscript editing. ZH: project development, data analysis, manuscript writing.

Corresponding author

Correspondence to Zachary Hamilton.

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The authors declare that they have no conflict of interest.

Ethical approval

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.

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Davaro, F., Schaefer, J., May, A. et al. Invasive non-urachal adenocarcinoma of the bladder: analysis of the National Cancer Database. World J Urol 37, 497–505 (2019). https://doi.org/10.1007/s00345-018-2411-7

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  • DOI: https://doi.org/10.1007/s00345-018-2411-7

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