Trends of incidence and prognosis of primary adenocarcinoma of the bladder

Abstract

Background: Primary adenocarcinoma of the bladder (ACB) is a rare malignant tumor of the bladder with limited understanding of its incidence and prognosis. Methods: Patients diagnosed with ACB between 2004 and 2015 were obtained from the SEER database. The incidence changes of ACB patients between 1975 and 2016 were detected by Joinpoint software. Nomograms were constructed based on the results of multivariate Cox regression analysis to predict overall survival (OS) and cancer-specific survival (CSS) in patients with ACB, and the constructed nomograms were validated. Results: The incidence of ACB was trending down from 1991 to 2016. A total of 1039 patients were included in the study and randomly assigned to the training cohort (727) and validation cohort (312). In the training cohort, multivariate Cox regression showed that age, marital status, primary site, histology type, grade, AJCC stage, T stage, SEER stage, surgery, radiotherapy, and chemotherapy were independent prognostic factors for OS, whereas these were age, marital status, primary site, histology type, grade, AJCC stage, T/N stage, SEER stage, surgery, and radiotherapy for CSS. Based on the above Cox regression results, we constructed prognostic nomograms for OS and CSS in ACB patients. The C-index of the nomogram OS was 0.773 and the C-index of CSS was 0.785, which was significantly better than the C-index of the TNM staging prediction model. The area under the curve (AUC) and net benefit of the prediction model were higher than those of the TNM staging system. In addition, the calibration curves were very close to the ideal curve, suggesting appreciable reliability of the nomograms. Conclusion: The incidence of ACB patients showed a decreasing trend in the past 25 years. We constructed a clinically useful prognostic nomogram for calculating OS and CSS of ACB patients, which can provide a personalized risk assessment for ACB patient survival.

Competitive Risk Model for Specific Mortality Prediction in Patients with Bladder Cancer: A Population-Based Cohort Study with Machine Learning

“…Our model contained the following variables produced from clinical practice: age at diagnosis, marital status at diagnosis, sex, primary site-labeled, grade, ICD-O-3 hist/behav, derived AJCC stage group 7th ed (2010–2015), derived AJCC T 7th ed (2010–2015), RX Summ-surg prim site (1998+), chemotherapy recode (yes, no/unk), CS tumor size (2004–2015), the total number of in situ/malignant tumors for patients, in which age was a significant risk variable for the bladder cancer-specific mortality, suggesting that the risk of death in bladder cancer patients would increase significantly with age. Prognostic analyses for bladder cancer conducted by other studies also showed that age played a crucial role in cancer death, and the death rate in patients increased with the increase of age at diagnosis [ 23 , 24 ]. Another risk factor appeared to be sex.…”

International Society of Urological Pathology (ISUP) Consensus Conference on Current Issues in Bladder Cancer. Working Group 2

“…Zaghloul et al 117 showed significantly different distant metastasis-free rates among the three adenocarcinoma grades, although it had no significant effect on survival. Several recent studies on bladder adenocarcinomas (including urachal adenocarcinoma) from the SEER database showed grade (with varied cutoffs) to be an independent predictor of outcome 118–121 …”

“…Several recent studies on bladder adenocarcinomas (including urachal adenocarcinoma) from the SEER database showed grade (with varied cutoffs) to be an independent predictor of outcome. [118][119][120][121] Proposal and Voting…”