Clinicopathological characteristics of urothelial bladder cancer in patients less than 40 years old

Abstract

Urothelial bladder cancer (UBC) is rare in young patients and as a result little information as to tumor type and clinical course are available. We present clinicopathological data of a large series of patients less than 40 years with bladder carcinoma. We included in this retrospective study covering the period from 1992 to 2013 patients less than 40 years with a first diagnosis of bladder cancer. Lesions were classified according to the WHO 2004 classification by uropathologists of ten centers. Stage, grade, multifocality, smoking habits, recurrence, and survival were studied. The cohort comprised of 152 patients, 113 males and 39 females with a mean age of 33.2 years. The large majority of the patients (142) was diagnosed with an urothelial carcinoma, the ten others with various histopathological diagnoses. In the age group less than 30 years old, 40.3 % of the cases concerned a papillary urothelial neoplasia of low malignant potential (PUNLMP). In the age group over 30 years, the proportion of PUNLMP decreased to 27.2 %. Only 5.6 % of the UBC was associated with carcinoma in situ. In 14.1 %, a high grade muscle invasive UC was found; 7.0 % had lymph node and 4.9 % distant metastasis at time of presentation. Four patients presented with a history of schistosomiasis; all had an infiltrating carcinoma. After initial resection, 36 patients relapsed, 17 % as PUNLMP, 53 % as pTa low grade, and 30 % as pTa-pT2 high grade UC. During follow-up, 6 % of the patients died. PUNLMP is the most frequent entity in this patient group. It is important that the PUNLMP entity is maintained in future classification systems.

Bladder cancer in patients under 40 years. A French experience and a review of the recent literature.

“…Major environmental risk factors are smoking or professional exposure during several years (probably around 20 years) (15). Male predominance is noted in most studies, similar to that reported in older patients, but also similar to studies in very young patients under 20 years (9 Up to date, only one original study with more than 150 cases for UBC in young patients has been published and another with more than 100 cases (11,14). In the largest study with more than 150 patients, the authors show that most patients displayed not invasive urothelial carcinomas; carcinoma in situ was a rare finding.…”

“…Nevertheless, many authors make a difference between <20 years and < 40 years, knowing that the group 30-40 years approaches to the patients diagnosed with UBC in older age (14). The second problem are the cases observed in children or young adults, mostly under 15 years, frequently first treated in pediatric structures, and later followed-up in adults hospitals, those patients might get lost in studies.…”

Determinants of Survival for Adolescents and Young Adults with Urothelial Bladder Cancer: Results from the California Cancer Registry

“…(6) In contrast, a paper on 152 young bladder cancer patients reported that in those less than 30 years of age, 40.3% had a papillary urothelial neoplasia of low malignant potential. (11) In addition, the field is complicated by the variability of definitions of what constitutes a “young patient”. Most published series define “young” as less than 40 years of age.…”

Urothelial bladder cancer in young adults: Diagnosis, treatment and clinical behaviour

“…In their study with 152 UBC patients under 40, Comperat and colleagues reported that the most important factors that affect disease prognosis are histopathological grade and tumour stage. 1 In our study, we also determined that both tumour grade and stage affect recurrence and progression. Bladder cancers in younger patients were single-focused tumours.…”

“…Low-grade papillary carcinomas have an advantage of longer survival rates, even though they frequently recur since they are usually not muscle invasive. 1 On the contrary, high-grade urothelial cancers tend to be invasive in nature and carry a serious risk of progression which can lead to metastasis. These tumour occurrence rates peak around the 6th decade of life.…”