A histopathological study of bladder cancer in Uganda
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Abstract
Background: The incidence of squamous cell carcinoma (SCC) and adenocarcinoma of the bladder have been higher than that of urothelial carcinoma (UC) in several African countries for nearly five decades. However, this trend has changed over time, with various countries reporting rising numbers of UC against other forms of bladder cancer. We carried out a histopathological study of bladder tumours in Uganda to objectively realign the clinical and public health interventions.
Methods: We conducted a five-year descriptive cross-sectional study. In total, 117 samples that fit the inclusion criteria were consecutively selected and re-examined from a pool of 282 archived formalin-fixed paraffin-embedded (FFPE) bladder cancer tissue blocks. The independent variables studied were age and sex; the outcome variables were histological type, lymphovascular invasion and variant morphologies measured as proportions with their 95% confidence intervals. Crude associations between bladder cancer types and the independent variables were assessed using Pearson’s chi-square and Fisher’s exact tests accordingly. A p-value < 0.05 was considered statistically significant.
Results: The male-to-female ratio (M:F) was 1:1.7, whereas the mean and standard deviation of the participants’ ages was 59 ± 15 years. The most common histological type was UC (107; 91.4%), of which 63 (58.9%) were muscle-invasive. SCC and adenocarcinoma had proportions of 6.0% (2.4–11.9) and 2.6% (0.5–7.3), respectively. The most common variant morphologies of UC were nested (14.3%),
microcytic (12.7%) and squamous differentiation (7.9%). Lymphovascular invasion (LVI) was seen in 79.4% of the samples with muscle-invasive UC. There was no association between any bladder cancer type and age or sex.
Conclusion: Although SCC and adenocarcinoma were once the most common bladder cancer types in Uganda, current histopathological findings indicate that UC is now 15 times more frequent than SCC and 35 times more common than adenocarcinoma.