Clinical-pathologic characterisation and survival of children with Urinary Bladder Tumors at Uganda Cancer Institute.

Abstract

Introduction: Pediatric bladder tumors are rare worldwide and their clinical-pathological characteristics differ from those in adults. In Uganda, these characteristics have not been studied in this age group yet survival has been anecdotally reported be poor at Uganda Cancer Institute. We proposed to describe the clinical-pathologic characteristics and determine survival among children with bladder tumors at UCI. General objective: To describe the clinical-pathologic characteristics and determine survival of children with urinary bladder tumors registered at Uganda Cancer Institute between January 2009 and January 2020. Secondarily, assess how the characteristics and treatment modalities affect survival. Methods: We obtained ethical approval and conducted a retrospective chart review of children with a histological diagnosis of bladder tumors between January 2009 and January 2020 registered at UCI. The clinical-pathologic characteristics of the patients and treatment given were abstracted and analyzed. The 5-year survival was analyzed as time from histological diagnosis to death. The Kaplan Meier survival function was utilized to calculate the monthly event probabilities, median survival time and the yearly survival rate. Results: Of 4094 charts, 44 had bladder tumors. There was a bimodal age distribution with the peaks at 3 and 15years. The median duration of symptoms at admission was 56 days (IQR = 48). Commonest symptoms were hematuria (65.9%) and abdominal mass (61.4%). Rhabdomyosarcoma (65.9%) predominated; while urothelial tumors accounted for 13.6%. Most tumors were low grade; 21(48.8%) and stage 1; 15(34.1%) managed with combination therapy (81.8%). Event (death) occurred in 19 (43.2%) patients, the rest were either alive 12 (27.2%) or loss to follow up 13 (29.5%). Overall, the median survival time was 38 months and survival at 1, 3, and 5 years was 58.3%, 55.5% and 47.2% respectively. Conclusion: Bladder tumors are rare in children. Most presented with gross hematuria and an abdominal mass. Most tumors were Rhabdomyosarcoma, low grade and stage 1. However, 5-year survival was low at 47.2%. Those who presented with an abdominal mass, gross hematuria and combination treatment were associated with better survival. Therefore, we recommend that all children with bladder tumors receive treatment as per COG protocol. Key words: bladder tumor, clinical-pathologic characteristics, survival