Abstract
408 Background: Adenocarcinoma is a rare histological subtype of urinary tract cancer with limited data regarding risk factors, effectiveness of treatment, and prognostic factors. Methods: To identify prognostic features, we evaluated demographics, treatment, and progression-free and overall survival (PFS, OS) in a retrospective review of 49 pts with adenocarcinoma of the bladder (n=35), ureter (n=1), or urethra (n=13) evaluated at Cleveland Clinic from January 2000 to April 2016. Uni- and multi- variable analyses (UVA, MVA) were used to identify prognostic factors. OS was measured from diagnosis to death and PFS from diagnosis to first of recurrence/progression or death. Results: 25 (51%) pts were women, median age at diagnosis was 62 (33-82), 30 pts (61%) presented with hematuria, and 13/36 (36%) had hydronephrosis. Treatment included cystectomy in 43 pts (88%), neoadjuvant chemotherapy in 3 pts (MVAC, gemcitabine/cisplatin, paclitaxel/cisplatin), adjuvant chemotherapy in 2 pts (gemcitabine), and systemic therapy for advanced or recurrent disease in 6 pts. Overall, 23 pts (47%) recurred/progressed and 31 (63%) died [12 without recurrence/progression]. Estimated median OS and PFS from diagnosis were 38.1 and 24.5 months, respectively. Pts with hydronephrosis at time of diagnosis had shorter PFS (p=0.06) and OS (p=0.007). Among the cystectomy pts, MVA identified pN stage and presence of signet-ring cells or papillary component as the only independent predictors of OS, while pN stage was the only independent predictor of PFS. Combining these factors, 3 prognostic groups for OS were identified (Table). Conclusions: pN stage and morphology are independent predictors of OS in pts with urinary tract adenocarcinoma after radical surgery and can stratify pts into distinct prognostic groups. If validated in larger cohorts, these factors could be used for prognostication, clinical decision making, and trial stratification. [Table: see text]
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