الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Bladder cancer is the most common malignancy involving the urinary system and the tenth most common malignancy worldwide, bladder cancer is the fourth most common cancer and the fifth most leading cause of cancer death in Egypt. Bladder cancer is diagnosed in older individuals, with median age at diagnosis of 69 years in men and 71 in women. Bladder cancer is more common in male than in female with respective incidence and mortality rates of 9.6 and 3.2 per 100,000 in men: about four times those of women globally. Cigarette smoking is the most important factor contributing to the overall incidence of urothelial cancer in western countries. Bladder cancer divided into low-grade non-muscle invasive (“superficial”) cancers, which account for 70% of tumor incidence, are not immediately life threatening, but they have ability for recurrence which needs life-long surveillance. In contrast, high-grade muscle-invasive bladder cancers (MIBCs) progress rapidly to become metastatic and generate the bulk of patient mortality. Cisplatin-based chemotherapy is only effective in 30–40% of cases, and it is not yet possible to prospectively identify the patients who are likely to obtain benefit. Also, no effective alternative to cisplatin-based chemotherapy has been identified for resistant tumors. So, there is an urgent need to develop a more precise, biology-based approach to the classification of bladder cancer to inform clinical management. There are several classification of MIBC regarding gene expression & molecular status. In our study, MIBC classified depend on two markers (CK 5/6 & CK20) into (i) luminal subtype, exclusively CK20 positive and CK5 negative (CK20+/CK5-) (ii) basal subtype, exclusively CK5positive and CK20 negative (CK20-/ CK5+) (iii) non-basal non luminal subtype both markers positive (CK20+/CK5+) or both markers negative (CK20-/CK5-). We try in our study to correlate these molecular subtypes with response to neoadjuvant chemotherapy, concurrent chemoradio-therapy & survival (disease free survival, overall survival). This study carried out at Clinical Oncology Department, Tanta University Hospitals in corporation with Pathology Department, Faculty Of Medicine, Tanta University and included (70) patients with muscle invasive bladder cancer (MIBC) stage II and III throughout the period from January 2016 to January 2019. The study revealed that: - There was no statistically significant differences between the three studied groups regarding patient characteristic (age, sex & performance status) and smoking. - There was no statistically differences between the three studied groups regarding type of pathology most of patients were urothelial carcinoma (92.5%), (5%) were squamous cell carcinoma, while (2.5%) were adenocarcinoma. - There was significant increase in squamous and sarcomatoid differentiation in the basal subtypes (50 % of cases), there was significant increase in papillary variant in luminal subtypes (41.7% case). - There was significant difference regarding grading, 78.1% of cases in basal subtypes were high grade, 41.7% of cases in luminal subtypes were high grade & 71.4% of cases in non-luminal non basal subtypes were high grade. - There was significant statistically differences between the three studied groups regarding T tumor size 15( 46.9% of cases) in basal subtype were T3b ,13( 54.2% of cases) in luminal subtypes were T2b and 5(35.7% of cases) in Non basal-non-luminal were T2b&5( 35.7% of cases) were T3b. - There was no significant statistically differences between the three studied groups regarding N lymphnodes & staging. - There was no significant statistically differences between the three studied groups regarding multiplicity & site of tumor. - There was no significant statistically differences between the three studied groups regarding response to NAC - Regarding to response to CCRTh there was significant statistically differences between the three studied groups with significant increase in response in luminal subtype & non -basal-non-luminal compared with basal subtype which showing worse response. - There was significant increase in DFS & OS in luminal subtypes and non- basal non luminal compared to basal subtype.