Muscle-Invasive Bladder Cancer in Egypt: Pathologic Considerations Based on a Series of 581 Radical Cystectomies`
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Muscle-Invasive Bladder Cancer in Egypt: Pathologic Considerations Based on a Series of 581 Radical Cystectomies,ENMAR I. HABIB, ASHRAF A. MOSHARAFA, MOHAMMED H. ABD ELHAMID
Abstract
Objectives: To describe time-related changes in patholog-ical features of bladder cancer in Egypt based on a series of radical cystectomies, and to define certain pathological char-acteristics of bladder squamous cell carcinoma that may have important clinical implications.
Methods: Charts of patients undergoing radical cystectomy for muscle-invasive bladder cancer at Cairo University Hos-pitals between 1996 and 2008 were reviewed. We compared various pathological features between the two main types (transitional and squamous cell carcinoma), and we noted changes occurring over the 12 years of study.
Results: Our series includes 581 patients. The pathology was TCC in 334 (57.5%), SCC in 219 (37.7%) and other in 28 (4.8%). There was a significant increase in the percentage of TCC (48.2% Vs. 74.6%) and decrease in SCC (44.8% Vs. 23.8%) over the 12 years reviewed (p=0.001). We also noted a significant decline in the Bilharzial ova positivity from 70.9% in 1996-1998 to 52.2% in 2006-2008 (p=0.01). The majority of our patients had locally advanced (pT3) moderately to poorly differentiated tumors, however lymph node positive disease was significantly lower (at 14.6%) for our SCC patients, compared to TCC patients (27.2%) (p<0.001). There was a good correlation between the pre-operative and final pathology (type and grade) for TCC patients but not in 16 of SCC patients.
Conclusion: We describe a significant trend towards decreasing SCC and increasing TCC in patients undergoing radical cystectomy at our tertiary center in Cairo, Egypt. We also note some peculiar pathologic features in SCC cases (advanced local disease, lower lymph node involvement, and occasional inaccurate pre-operative biopsy results) which have important clinical implications.