title: Contemporary rates of pathological features and mortality for adenocarcinoma of the urinary bladder in the USA.
abstract: To examine contemporary rates of pathological features and mortality for adenocarcinoma of the urinary bladder in the USA using population-based data analysis.
  
  
  
  We relied on 10 024 patients with non-metastatic bladder cancer diagnosed between 2004 and 2013 within the Surveillance, Epidemiology and End Results registries. Logistic regression analyses focused on grade and stage. Kaplan-Meier analyses assessed cancer-specific mortality rates in adenocarcinoma and urothelial carcinoma of the bladder. Cox regression analyses assessed the impact of histological subtype on cancer-specific mortality.
  
  
  
  Overall, 215 (2.1%) adenocarcinoma and 9809 (97.9%) urothelial carcinoma patients were identified. The rate of non-organ-confined disease was higher in adenocarcinoma (64.7% vs 50.8%, P < 0.001). In multivariable logistic regression analyses, adenocarcinoma patients had a 2.2-fold higher risk of harboring non-organ-confined disease (95% confidence interval 1.7-3.0; P < 0.001) than urothelial carcinoma patients. Cancer-specific mortality-free survival rates were lower in adenocarcinoma (P < 0.01). This disadvantage only applied to non-organ-confined disease (P = 0.044), and not to organ-confined disease (P = 0.9). In multivariable Cox regression analyses, adenocarcinoma conferred a 1.3-fold higher rate of cancer-specific mortality (hazard ratio 1.30, 95% confidence interval 1.05-1.60; P = 0.01). Among adenocarcinoma patients, 30.7% harbored signet-ring cell adenocarcinoma and portended particularly poor cancer-specific mortality rates.
  
  
  
  In bladder cancer, adenocarcinoma presents at higher stages than urothelial carcinoma. However, cancer-specific mortality rates do not differ. A more unfavorable stage at diagnosis and higher cancer-specific mortality apply to the signet-ring cell variant.
authors.affiliation: Division of Oncology/Unit of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy.|Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Zaffuto
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Gazdovich
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.|Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Sami-Ramzi
authors.initials: SR
authors.lastname: Leyh-Bannurah
authors.affiliation: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.affiliation: Center for Outcomes Research Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Center for Outcomes Research Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Division of Oncology/Unit of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Division of Oncology/Unit of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D018279:Carcinoma, Signet Ring Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018426:SEER Program / Q000706:statistics & numerical data*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery
keywords: Surveillance, Epidemiology and End Results; adenocarcinoma; bladder cancer; mortality; signet-ring cells