Hydronephrosis as a Prognostic Factor in Primary Bladder Adenocarcinoma: Insights from a 15-Year Tertiary Center Experience

Objective This study aims to evaluate the clinicopathological features and oncological outcomes of primary bladder adenocarcinoma patients treated in a tertiary oncological center over 15 years. Methods Epidemiological, clinical, radiological, and anatomopathological data were collected from patients with urothelial carcinoma who underwent radical cystectomy in an oncological tertiary center between May 2008 and December 2023. We conducted univariate, multivariate, and survival analyses to identify risk factors associated with worse oncological prognosis. Results The study comprised 39 patients with a median age of 66 years (SD ±19) at the time of cystectomy, with a gender distribution of 19 males (48.7%) and 20 females (51.3%).Surgical approaches included 23.7% partial cystectomy and 76.3% radical cystectomy.In our study, most patients were staged as locally advanced (T3: 26.4%, T4: 35.3%), lymph node involvement positive in 32% of patients, lymphovascular invasion in 33% and hydronephrosis in 33%.Univariate analysis to assess factors associated with overall survival indicated significant associations with Karnofsky Performance Status (p=0.010; 95% CI 2.56 - 17.07), neutrophil-to-lymphocyte ratio (p=0.05; 95% CI -4.65 - 0.45), lymphovascular invasion (p=0.004; 95% CI 1.75 -7.32), and preoperative hydronephrosis. Further, multivariate analysis identified preoperative hydronephrosis as an independent predictor of poorer outcomes (p=0.025; 95% CI 0.07 - 0.722). Survival analysis corroborated this finding, highlighting preoperative hydronephrosis as a significant predictor of worse overall survival (Log-Rank test < 0.001; 95% CI 1.30 - 14.4). Conclusions The study highlighted the negative impact of preoperative hydronephrosis on overall survival in patients with primary bladder adenocarcinoma. The findings suggest that preoperative hydronephrosis should be considered a factor in risk stratification and postoperative management in patients with primary bladder adenocarcinoma.