A Histopathological Snapshot of Bladder Cancer: a Johannesburg Experience of 1480 Histopathology Reports

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Methods Following ethical clearance, a retrospective study of 1480 histopathological reports was done. Normality of distribution was tested using the Shapiro Wilk test. Histopathological results were compared by patient gender using the Fisher's exact, and by age, using either one-way ANOVA or the Kruskal-Wallis test. Results Urothelial carcinoma accounted for 88.8% of bladder cancer cases, squamous cell carcinoma (7.7%), adenocarcinoma (1.5%), and other malignancies (2%). High-grade urothelial carcinoma was the predominant subtype, accounting for 75% of cases. Non-muscle invasive disease accounted for 72% of these cases, while 28% were muscle invasive. Data from radical cystectomies showed a high proportion of aggressive and advanced disease. Conclusions The study highlights the predominance of high-grade non-muscle invasive bladder cancer in Johannesburg, consistent with global trends. However, the presence of advanced disease at diagnosis, particularly in cases needing radical cystectomy for urothelial carcinoma, and squamous cell carcinoma, reflects the ongoing challenges in early detection and treatment in this population. The findings suggest a shift in bladder cancer trends in Africa away from assumed squamous cell carcinoma towards urothelial carcinoma, possibly influenced by increasing urbanisation, smoking and changes in risk factor profiles. Bladder cancer Urothelial carcinoma Histopathology Johannesburg Squamous cell carcinoma Non-muscle invasive bladder cancer Muscle-invasive bladder cancer Introduction Bladder cancer is the 9th most common malignancy and the 13th most common cause of death globally according to the GLOBOCON statistics of 2022 [ 1 – 3 ]. It ranks as the fourth most common malignancy in males and the 11th most common malignancy in females worldwide [ 4 ]. According to the most recent data from the South African National Cancer Registry (NCR), bladder cancer accounted for 959 new cases in males (2.29%) and 340 new cases in females (0.74%) in 2022 [ 6 ]. Urothelial carcinoma (UC) is the most prevalent histopathological subtype worldwide, with non-muscle invasive bladder cancer (NMIBC) accounting for 70–75% of cases [ 2 , 3 ]. The remaining patients present with muscle-invasive bladder cancer (MIBC) [ 2 , 3 ]. While NMIBC is associated with a low mortality rate, it has high recurrence rates of approximately 70%, contributing to its significant prevalence, and high-risk NMIBC is estimated to have a progression rate of 45% within 5 years [ 3 , 7 ]. Risk factors for bladder cancer vary globally, with smoking and occupational exposure being the most significant predisposing factors in developed nations, particularly for UC [ 5 ]. In contrast, schistosomiasis (bilharzia) and chronic bladder irritation are the primary risk factors in developing countries, leading to a higher prevalence of squamous cell carcinoma (SCC) of the bladder [ 5 ]. However, with increasing urbanization in developing nations, these risk factors and associated data are evolving [ 7 ]. The prevalence of smoking worldwide is estimated to be 19%, and South Africa had a smoking prevalence of 24% in 2021[ 8 ]. Johannesburg currently has a population of more than 6 million people and represents an economic and employment hub in South Africa [ 9 ]. In addition to the growth of its own population, Johannesburg attracts many migrants from neighboring provinces and countries who seek employment [ 9 ]. Data on bladder cancer in Africa, including South Africa, is limited [ 5 ]. Although it is reported as one of the leading causes of cancer in Africa, with an estimated incidence of 7.1 per 100,000, the available data is sparse and largely outdated [ 2 ]. Table 1 shows a review of the current literature available in Africa. As shown in the table below, there was high heterogeneity in the types of studies performed, with small sample sizes. Table 1 Tabulation of Previous Published Data on Bladder Cancer from the Continent of Africa Author Publication Date Type of Study Units of Patients/Studies/samples Country Purpose of Study Key Findings of the Study Adeloye Et al 2019 Systematic Review 22 Studies 15 African countries Epidemiology of Bladder Cancer Rates of bladder cancer increasing Bowa Et al 2018 Systematic Review 23 Studies Sub-Saharan Africa Epidemiology of Bladder Cancer SCC Bladder Predominant Cassel et al 2019 Systematic Review 47 Studies 10 African countries Epidemiology of Bladder Cancer SCC Predominant However UC increasing Groeneveld Et al 1996 Retrospective Review 615 Patients KZN, South Africa Histological Variations in Racial Groups SCC in African patients, UC in Caucasian patients Saouli et al 2021 Retrospective Review 39 Patients Morocco Histological Variants in Bladder Cancer Predominance of Squamous and micropapillary differentiation Ssekitooleko et al 2024 Descriptive Cross-Sectional Study 117 Samples Uganda Epidemiology of Bladder Cancer UC most common finding in bladder cancer Yohana et al 2023 Retrospective Review 481 Patients Tanzania Trend of SCC Bladder SCC most common, increasing numbers of UC Materials and Methods After receiving ethical approval (clearance number: M231189), a retrospective review of histopathological reports (N = 2450) from 2010–2023 was performed. The hospital is an academic center and provides pathology services to nine other peripheral hospitals. A total of 2450 specimens were initially reviewed. TURBTs and radical cystectomy (RC) specimens were included (N = 1480 pathology reports, total number of patients 858 owing to those patients who had multiple TURBTS). Non-primary bladder carcinomas (N = 970) were excluded. Statistical analysis An observational, descriptive study of histopathological reports was performed. The data was analyzed using IBM SPSS statistics software, version 29. The patient demographics and clinical profiles are shown as counts (N) and percentages (%) for categorical variables. For numerical variables, the results are reported as the means with standard deviations (for normally distributed data) and as medians with interquartile ranges (for nonnormally distributed data). The normality of the distribution was tested via the Shapiro‒Wilk test. Histopathological results were compared by patient sex via Fisher's exact test as well as by patient age via either one-way ANOVA or the Kruskal‒Wallis test (for nonnormally distributed data). All the results of all the statistical analyses were considered significant at p values < 0.05. Results In terms of patient demographics, our study revealed that 75% (N = 644) of patients diagnosed with bladder cancer were male and that 25% (N = 214) were female. The mean age at presentation was 62 years. The youngest patient in our study was 4 years old (who had rhabdomyosarcoma of the bladder), and the oldest was 94 years old, with a standard deviation of 13.1 years. In our study, 88% of patients (N = 760) underwent TURBTs, whether single or repeat procedures, whereas 11.4% (N = 98) underwent radical cystectomy. Table 2 shows a histological overview of the bladder carcinomas identified in this study. Major Subtypes Histological subtype N = Total number of Patients % Urothelial carcinoma 762 88.8% Squamous cell carcinoma 66 7.7% Adenocarcinoma 13 1.5% Other Malignancies 17 2% Total 858 100% Urothelial Carcinoma (N = 762) Diagnostic age related data Age Mean 64.3 95% Confidence Interval for Mean Lower Bound 63.5 Upper Bound 65.2 Median 66.0 Std. Deviation 12.1 Interquartile Range 57.0–73.0 Skewness -0.6 Demographics & Malignancy Related Data N = Total number of Patients % Sex M 600 79% F 162 21% Procedure Type TURBT 674 88% Radical Cystectomies 88 12% Grades of Urothelial Carcinoma Low Grade 190 25% High Grade 572 75% Stages of Urothelial Carcinoma Non-Muscle Invasive Disease (N = 535) CIS 5 0.6% Ta 291 40% T1 239 32% Muscle Invasive Disease (N = 250) T2 165 19% T3 52 4% T4 33 5% Squamous Cell Carcinoma (N = 66) Diagnostic age related data Age Mean 52.2 95% Confidence Interval for Mean Lower Bound 48.7 Upper Bound 55.8 Median 50.5 Std. Deviation 14.5 Interquartile Range 40.8–62.5 Skewness 0.3 Demographics & Malignancy Related Data N = Total number of Patients % Sex M 27 41% F 39 59% Procedure Type TURBT 58 88% Radical Cystectomies 8 12% Stages of Squamous Cell Carcinoma at Radical Cystectomy T1 0 0 T2 1 13% T3 2 25% T4 5 62% Adeno- carcinoma (N = 13) Stages Of Adenocarcinoma at Radical Cystectomy T1 0 0 T2 0 0 T3 1 50% T4 1 50% Other Malignancies (N = 14) Types of Carcinoma N = Total number of Patients % Spindle Cell Sarcoma 3 21% Rhabdomyosarcoma 1 8% Neuro-Endocrine Tumour 7 50% Non-Hodgkin Lymphoma 1 7% Clear Cell Mullerian Type 2 14% Table 2 : Overview of Characteristics of Bladder Carcinoma UC accounted for 88% of the cases (N = 762). SCC accounted for 7.7% (N = 66), and primary bladder adenocarcinoma (AC) accounted for 1.5% (N = 13). Other primary bladder malignancies were grouped together and accounted for 2% of the tumors (N = 17). With respect to urothelial carcinoma, 88% (N = 674) of our samples were from TURBTS, whereas 12% (N = 88) were from RC. Males accounted for 79%, whereas females accounted for 21%. The mean age at diagnosis was 64 years. High-grade UC was found in 75% of patients (N = 572), whereas low-grade urothelial carcinoma was found in 25% (N = 190) of the patients. Carcinoma in situ (CIS) was found in 7.3% (N = 56) of the samples. NMIBC accounted for 72% (N = 535) of the cases, whereas MIBC was found in 28% of the cases (N = 250). With respect to the TURBT data for UC, 27% of the samples were low grade, whereas 73% of the samples were high grade. Detrusor muscle represented 43% of the cases in our dataset, and muscle invasion was present in 23% of cases. The remainder of patients were diagnosed with NMIBC, and stage Ta accounted for 41% of cases, while stage T1 accounted for 35% of the patients. CIS was found in 6% of the TURBT specimens, and lymphovascular invasion (LVI) was identified in 1.8% of the cases. Squamous differentiation was found in 8% of the TURBT samples. Cystitis cystica was found in 2% of the samples, and cystitis glandularis was found in 0.4% of the samples. Von Brunn’s nests, follicular cystitis and adenomatous differentiation were observed in 0.1% of the patients. An incidental finding of schistosomiasis in TURBT samples for urothelial carcinoma was noted in 1.3% of the samples. We assessed the clinical characteristics by sex, and our study revealed no significant difference between the grade of tumors and NMIBC versus MIBC between males and females (p value < 0.5). Among the RCs performed for UC, 87% of the samples had high-grade disease, and MIBC accounted for 77% of the samples. The remainder were for NMIBC, and only 12% of these were low-grade specimens. CIS was found in 15% of the RC samples. LVI was found in 37% of the samples in this group. Squamous differentiation was observed in 5% of the patients, glandular differentiation in 1%, and sarcomatoid features in 6% of the patients. Cystitis cystica was found in 4% of these cases, and cystitis glandularis was observed in 1% of the cases. Schistosomiasis was observed in 1% of the RC samples. With respect to the involvement of local structures, the prostate was involved in 15% of cases, the lymph nodes were positive in 29%, ureteric involvement was observed in 7%, and seminal vesicles were observed in 5% of cases. Carcinoma was upstaged from TURBT in 35% of the patients. Incidental prostate adenocarcinoma was found in 10% of patients in our current study, with Gleason 3 + 3 (WHO Grade Group 1) carcinomas being the predominant finding. In cases where multiple TURBTs were performed for the same patient or in cases where one patient progressed from TURBT to radical cystectomy, progression data were recorded. Our study revealed that all cases of CIS progressed. High-grade UC progressed in 30% of the patients, did not progress in 50%, and regressed in 19% of the patients. Low-grade UC progressed in 23% of the patients, did not progress in 56%, and regressed in 21%. Our study revealed SCC in 7% of the patients. TURBTs accounted for 88% (N = 58) of the cases in this group, whereas RC specimens accounted for 12% (N = 8) of the cohort. The mean age at diagnosis for SCC patients was 52 years; males accounted for 41% (N = 27) of the patients, whereas females accounted for 59% (N = 39) of the patients. Schistosomiasis was present in 38% of the samples. The limited number of RCs included advanced-stage disease (T2b-12%, T3b-25%, and T4-62% of cases). Primary bladder adenocarcinoma was found in less than 2% of the specimens (N = 13). Other malignancies accounted for 2% of all cases and included spindle cell sarcoma, neuroendocrine tumors, rhabdomyosarcomas, lymphomas and clear cell carcinoma of the Mullerian type. Discussion This study provides valuable insights into the histopathological patterns of bladder cancer in Johannesburg, South Africa, and addresses a significant gap in the literature. Our findings indicate a predominance of bladder cancer diagnoses in male patients, which is consistent with previous studies reporting that bladder cancer is up to four times more common in males [ 3 ]. This gender disparity is often attributed to delayed diagnosis, differing help-seeking behaviors, and increased exposure to smoking and occupational hazards in males [ 2 ]. Our study confirms that UC is the most prevalent form of bladder cancer, which aligns with both international and limited African studies [ 2 – 4 ]. Historically, squamous cell carcinoma (SCC) has been the dominant histopathological subtype of bladder cancer in African countries because of the high incidences of schistosomiasis and schistosomal cystitis [ 5 – 7 , 11 ]. However, with increasing urbanization and efforts to control schistosomiasis, the incidence of UC is increasing, particularly in nonendemic areas such as Johannesburg [ 4 , 7 , 11 ]. The study also revealed a predominance of nonmuscle invasive bladder cancer (NMIBC), which is consistent with global trends, where 75–80% of UC cases are reported as NMIBC [ 2 ]. Limited African data corroborate this finding, with NMIBC occurring in 75–85% of cases [ 4 ]. A previous study from 1996 indicated that 76% of UC cases in South Africa were staged as T1 tumors, which mirrors our current findings [ 7 ]. Seventy-five percent of NMIBC cases are high-grade [ 12 ]. High-grade tumors are associated with increased progression rates, necessitating specific risk stratification strategies for proper patient management [ 3 ]. Our study revealed that high-grade UC progressed in 30% of patients, with 23% of low-grade patients also showing progression. Furthermore, all cases of CIS progressed to either high-grade disease or required radical cystectomy. This study highlighted associations between certain pathological findings and clinical outcomes. Our study revealed CIS in 6% of TURBT patients, whereas the presence of CIS at TURBT has been reported with a wide incidence range of 24–59% [ 14 ]. This variability is likely due to sampling errors and the positioning of the CIS relative to the tumor, prompting some authors to advocate for random bladder sampling, enhanced cystoscopy, and urine cytology to increase the detection of the CIS [ 11 , 14 ]. Histopathological variants of UC, including squamous and glandular differentiation, micropapillary, plasmacytoid, sarcomatoid, and nested variants, have been reported in more than 25% of cases and are generally associated with a more aggressive clinical course. [ 3 , 12 ]. In our study, squamous differentiation was observed in 8% of the TURBT samples and 5% of the RC samples. Squamous differentiation is linked to faster disease progression and higher recurrence rates; hence, rapid definitive treatment is recommended when it is detected [ 2 ]. Glandular differentiation, reported to occur in 18% of cases, is associated with poorer prognosis and was found in 1% of our radical cystectomy cohort [ 12 ]. RC was primarily performed for MIBC, with 87% of these specimens found to have high-grade disease. CIS at RCs is associated with higher recurrence rates, and our study revealed that the incidence of CIS at RCs was 15%, which is lower than that reported in the literature but higher than our TURBT findings [ 3 , 13 ]. Lymph node involvement, which was present in 29% of the patients in our study, remains a critical prognostic factor, with an increasing number of positive nodes correlated with increased recurrence risk [ 11 ]. Additionally, 35% of carcinoma cases at RCs are upstaged from the original TURBT, which has been associated with higher rates of additional lymph node involvement and impacts recurrence and overall survival [ 3 ]. Incidental prostate adenocarcinoma was found in 10% of cases, predominantly with a combined Gleason score of 6, which equates to WHO grade group 1. This aligns with reported rates of incidental prostate carcinoma at RCs, which range between 24% and 51% [ 16 ]. Most incidental prostate cancer cases are organ confined and clinically insignificant, possibly reflecting the high incidence of both cancers in an aging population [ 16 , 17 ]. Bladder SCC accounted for nearly 7% of the cases, with most samples being TURBTs and very few RCs being performed. This is likely because 27% of patients present with advanced-stage disease at the outset, rendering many patients inoperable at diagnosis [ 4 , 7 , 11 ]. SCC is often muscle invasive and has an advanced stage of disease (T3/T4) at initial presentation, accounting for approximately 90% of cases [ 7 , 11 ]. Our study revealed that SCC patients were diagnosed at a younger age than UC patients were, which aligns with reported trends [ 7 ]. However, we observed a female predominance (59%), whereas the literature typically reports a male predominance [ 7 ]. Schistosomiasis was detected in 38% of the SCC patients in our study, with reports in a limited number of African studies ranging from 45–85% [ 7 ]. RC for SCC shows a predominance of higher-stage disease, which is consistent with the literature indicating that most SCC cases are muscle invasive at diagnosis, potentially due to differences in pathogenesis and tumor spread [ 7 , 11 ]. Our study revealed primary bladder adenocarcinoma in 1.5% of the samples. Primary bladder adenocarcinoma is staged higher than UC at diagnosis, with the involvement of local structures, which is consistent with the limited literature on this clinical entity [ 11 ]. Other malignancies were observed only in a small percentage of our cohort. Patients presenting with these malignancies often face challenges due to their aggressive nature and poor prognosis [ 11 ]. Furthermore, treatment options for these malignancies are controversial and widely debated owing to the small number of guidelines and treatment algorithms. For such patients, the trend is toward early RC [ 11 ]. Conclusion This study evaluated the histopathological features of bladder cancer in Johannesburg Province over 13 years and revealed a predominance of high-grade NMIBC. RC performed for muscle-invasive disease revealed histologically advanced disease with significant lymph node involvement, likely due to the predominance of high-grade UC. Our study revealed low levels of SCC, possibly because Johannesburg is not an endemic bilharzia area, although the SCC cases observed in our study were found to have relatively high pathological stages. Importantly, despite Johannesburg not being endemic for bilharzia, referral patterns bring many nonlocal patients to our hospital seeking healthcare. Our findings suggest a shift in bladder cancer trends in Africa away from SCC toward UC, influenced by urbanization and a high prevalence of smoking. The large cohort of patients in the NMIBC group reflects the high morbidity of bladder cancer, the likely high return of patients to the health care system repeatedly, high repeat procedure rates and risk of progression of their malignancy. Therefore, smoking, the greatest risk factor for bladder cancer, is increasing in the rapidly growing population. On the basis of this reported information, a better anti-smoking campaign and more effective prevention strategies are strongly recommended. Continued efforts toward the treatment and screening of Bilharzia are equally imperative owing to the advanced clinical presentation of these patients. Strengths and weaknesses of the study The strengths of this study include its large number of urothelial carcinoma TURBT data. Weaknesses include the retrospective nature of the study as well as the lack of prospective data on the patients included. Declarations Author Contribution JJ - carried out the research and data analysis and wrote the main manuscriptAA - supervisor of the research, study design and methods, edited the manuscriptRW - supervisor of the research, study design and methods, edited the manuscript Acknowledgement The authors would like to acknowledge NHLS for granting full access to the histopathological data reviewed in this research. Data Availability Data is provided within the manuscript References https://www.uicc.org/news/globocan-2022-latest-global-cancer-data-shows-rising-incidence-and-stark-inequities. 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Cite Share Download PDF Status: Published Journal Publication published 11 Mar, 2025 Read the published version in World Journal of Urology → Version 1 posted Editorial decision: Revision requested 31 Dec, 2024 Reviews received at journal 15 Dec, 2024 Reviewers agreed at journal 11 Dec, 2024 Reviews received at journal 26 Nov, 2024 Reviewers agreed at journal 26 Nov, 2024 Reviewers invited by journal 21 Nov, 2024 Editor assigned by journal 12 Nov, 2024 Submission checks completed at journal 12 Nov, 2024 First submitted to journal 05 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5397979","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":382792946,"identity":"2ce488b5-51c5-408b-b159-808e89ea2045","order_by":0,"name":"Jaclyn Jonosky","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYBACxgYQWWDBA+FWSDDwASkJwloMJIBamIGMMxIMbIS0QIABSA1QC2MbA2EtzO1nzCR+GEjImPOvP/i4cJ6FPBt7j+ENhhqbaJwO60lLk+wBOsxyxmNm45nbJAzbeM4YWzAcS8ttwOmX5GM3eIBaDG4cZpPm3SaRwCaRYybB2HAYt5b+h203/8C1zCFGy4zkY7fBtpxvBmppIErLs/TfMmBbmI2NeY6B/HKs2CIBj18M+3OMDd9U2NgbnD/48DFPTZ08P3vzxhsfamxwa4FLSCQgCSegq0MC8nAW/wE8ykbBKBgFo2BEAwAh3E21Q+2NqgAAAABJRU5ErkJggg==","orcid":"","institution":"University of the Witwatersrand","correspondingAuthor":true,"prefix":"","firstName":"Jaclyn","middleName":"","lastName":"Jonosky","suffix":""},{"id":382792947,"identity":"ea02149a-310b-4b30-a9e3-3ad8d8786701","order_by":1,"name":"Ahmed Adam","email":"","orcid":"","institution":"University of the Witwatersrand","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Adam","suffix":""},{"id":382792948,"identity":"d6bab9b0-b447-493d-bd31-baa7aa5146b6","order_by":2,"name":"Reubina Wadee","email":"","orcid":"","institution":"University of the Witwatersrand","correspondingAuthor":false,"prefix":"","firstName":"Reubina","middleName":"","lastName":"Wadee","suffix":""}],"badges":[],"createdAt":"2024-11-05 20:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5397979/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5397979/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00345-025-05540-5","type":"published","date":"2025-03-11T15:58:32+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":78689198,"identity":"c43d2faf-89d1-44f2-88fc-aad0d149347f","added_by":"auto","created_at":"2025-03-17 16:12:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":978946,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5397979/v1/74d891b2-e6f7-481f-be8a-c1333c5df9ce.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Histopathological Snapshot of Bladder Cancer: a Johannesburg Experience of 1480 Histopathology Reports","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBladder cancer is the 9th most common malignancy and the 13th most common cause of death globally according to the GLOBOCON statistics of 2022 [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It ranks as the fourth most common malignancy in males and the 11th most common malignancy in females worldwide [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. According to the most recent data from the South African National Cancer Registry (NCR), bladder cancer accounted for 959 new cases in males (2.29%) and 340 new cases in females (0.74%) in 2022 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUrothelial carcinoma (UC) is the most prevalent histopathological subtype worldwide, with non-muscle invasive bladder cancer (NMIBC) accounting for 70\u0026ndash;75% of cases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The remaining patients present with muscle-invasive bladder cancer (MIBC) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. While NMIBC is associated with a low mortality rate, it has high recurrence rates of approximately 70%, contributing to its significant prevalence, and high-risk NMIBC is estimated to have a progression rate of 45% within 5 years [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRisk factors for bladder cancer vary globally, with smoking and occupational exposure being the most significant predisposing factors in developed nations, particularly for UC [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In contrast, schistosomiasis (bilharzia) and chronic bladder irritation are the primary risk factors in developing countries, leading to a higher prevalence of squamous cell carcinoma (SCC) of the bladder [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, with increasing urbanization in developing nations, these risk factors and associated data are evolving [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prevalence of smoking worldwide is estimated to be 19%, and South Africa had a smoking prevalence of 24% in 2021[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Johannesburg currently has a population of more than 6\u0026nbsp;million people and represents an economic and employment hub in South Africa [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In addition to the growth of its own population, Johannesburg attracts many migrants from neighboring provinces and countries who seek employment [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eData on bladder cancer in Africa, including South Africa, is limited [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although it is reported as one of the leading causes of cancer in Africa, with an estimated incidence of 7.1 per 100,000, the available data is sparse and largely outdated [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows a review of the current literature available in Africa. As shown in the table below, there was high heterogeneity in the types of studies performed, with small sample sizes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTabulation of Previous Published Data on Bladder Cancer from the Continent of Africa\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublication Date\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eType of Study\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnits of Patients/Studies/samples\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePurpose of Study\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eKey Findings of the Study\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdeloye Et al\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSystematic Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 Studies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 African countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEpidemiology of Bladder Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRates of bladder cancer increasing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBowa Et al\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSystematic Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 Studies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSub-Saharan Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEpidemiology of Bladder Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSCC Bladder Predominant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCassel et al\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSystematic Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 Studies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 African countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEpidemiology of Bladder Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSCC Predominant However UC increasing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroeneveld Et al\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e615 Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKZN, South Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHistological Variations in Racial Groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSCC in African patients, UC in Caucasian patients\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaouli et al\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMorocco\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHistological Variants in Bladder Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePredominance of Squamous and micropapillary differentiation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSsekitooleko et al\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDescriptive Cross-Sectional Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117 Samples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEpidemiology of Bladder Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eUC most common finding in bladder cancer\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYohana et al\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e481 Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTanzania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTrend of SCC Bladder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSCC most common, increasing numbers of UC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eAfter receiving ethical approval (clearance number: M231189), a retrospective review of histopathological reports (N\u0026thinsp;=\u0026thinsp;2450) from 2010\u0026ndash;2023 was performed. The hospital is an academic center and provides pathology services to nine other peripheral hospitals. A total of 2450 specimens were initially reviewed. TURBTs and radical cystectomy (RC) specimens were included (N\u0026thinsp;=\u0026thinsp;1480 pathology reports, total number of patients 858 owing to those patients who had multiple TURBTS). Non-primary bladder carcinomas (N\u0026thinsp;=\u0026thinsp;970) were excluded.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAn observational, descriptive study of histopathological reports was performed. The data was analyzed using IBM SPSS statistics software, version 29. The patient demographics and clinical profiles are shown as counts (N) and percentages (%) for categorical variables. For numerical variables, the results are reported as the means with standard deviations (for normally distributed data) and as medians with interquartile ranges (for nonnormally distributed data). The normality of the distribution was tested via the Shapiro‒Wilk test. Histopathological results were compared by patient sex via Fisher's exact test as well as by patient age via either one-way ANOVA or the Kruskal‒Wallis test (for nonnormally distributed data). All the results of all the statistical analyses were considered significant at p values\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn terms of patient demographics, our study revealed that 75% (N\u0026thinsp;=\u0026thinsp;644) of patients diagnosed with bladder cancer were male and that 25% (N\u0026thinsp;=\u0026thinsp;214) were female. The mean age at presentation was 62 years. The youngest patient in our study was 4 years old (who had rhabdomyosarcoma of the bladder), and the oldest was 94 years old, with a standard deviation of 13.1 years. In our study, 88% of patients (N\u0026thinsp;=\u0026thinsp;760) underwent TURBTs, whether single or repeat procedures, whereas 11.4% (N\u0026thinsp;=\u0026thinsp;98) underwent radical cystectomy.\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eshows a histological overview of the bladder carcinomas identified in this study.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eMajor Subtypes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eHistological subtype\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;Total number of Patients\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUrothelial carcinoma\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e762\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e88.8%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSquamous cell carcinoma\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e7.7%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAdenocarcinoma\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1.5%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOther Malignancies\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e858\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"21\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrothelial Carcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N\u0026thinsp;=\u0026thinsp;762)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnostic age related data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e95% Confidence Interval for Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUpper Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInterquartile Range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.0\u0026ndash;73.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSkewness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographics \u0026amp; Malignancy Related Data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u0026thinsp;=\u0026thinsp;Total number of Patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eProcedure Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTURBT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e674\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRadical Cystectomies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrades of Urothelial Carcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow Grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh Grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e572\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eStages of Urothelial Carcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eNon-Muscle Invasive Disease (N\u0026thinsp;=\u0026thinsp;535)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eMuscle Invasive Disease (N\u0026thinsp;=\u0026thinsp;250)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"17\"\u003e\n \u003cp\u003e\u003cstrong\u003eSquamous Cell Carcinoma (N\u0026thinsp;=\u0026thinsp;66)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnostic age related data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e95% Confidence Interval for Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUpper Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInterquartile Range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.8\u0026ndash;62.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSkewness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographics \u0026amp; Malignancy Related Data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u0026thinsp;=\u0026thinsp;Total number of Patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eProcedure Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTURBT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eRadical Cystectomies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eStages of Squamous Cell Carcinoma at Radical Cystectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdeno-\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ecarcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N\u0026thinsp;=\u0026thinsp;13)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eStages Of Adenocarcinoma at Radical Cystectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMalignancies\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N\u0026thinsp;=\u0026thinsp;14)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eTypes of Carcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u0026thinsp;=\u0026thinsp;Total number of Patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpindle Cell Sarcoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRhabdomyosarcoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeuro-Endocrine Tumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-Hodgkin Lymphoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClear Cell Mullerian Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e: Overview of Characteristics of Bladder Carcinoma\u003c/p\u003e\n\u003cp\u003eUC accounted for 88% of the cases (N\u0026thinsp;=\u0026thinsp;762). SCC accounted for 7.7% (N\u0026thinsp;=\u0026thinsp;66), and primary bladder adenocarcinoma (AC) accounted for 1.5% (N\u0026thinsp;=\u0026thinsp;13). Other primary bladder malignancies were grouped together and accounted for 2% of the tumors (N\u0026thinsp;=\u0026thinsp;17).\u003c/p\u003e\n\u003cp\u003eWith respect to urothelial carcinoma, 88% (N\u0026thinsp;=\u0026thinsp;674) of our samples were from TURBTS, whereas 12% (N\u0026thinsp;=\u0026thinsp;88) were from RC. Males accounted for 79%, whereas females accounted for 21%. The mean age at diagnosis was 64 years.\u003c/p\u003e\n\u003cp\u003eHigh-grade UC was found in 75% of patients (N\u0026thinsp;=\u0026thinsp;572), whereas low-grade urothelial carcinoma was found in 25% (N\u0026thinsp;=\u0026thinsp;190) of the patients. Carcinoma in situ (CIS) was found in 7.3% (N\u0026thinsp;=\u0026thinsp;56) of the samples. NMIBC accounted for 72% (N\u0026thinsp;=\u0026thinsp;535) of the cases, whereas MIBC was found in 28% of the cases (N\u0026thinsp;=\u0026thinsp;250).\u003c/p\u003e\n\u003cp\u003eWith respect to the TURBT data for UC, 27% of the samples were low grade, whereas 73% of the samples were high grade. Detrusor muscle represented 43% of the cases in our dataset, and muscle invasion was present in 23% of cases. The remainder of patients were diagnosed with NMIBC, and stage Ta accounted for 41% of cases, while stage T1 accounted for 35% of the patients. CIS was found in 6% of the TURBT specimens, and lymphovascular invasion (LVI) was identified in 1.8% of the cases. Squamous differentiation was found in 8% of the TURBT samples. Cystitis cystica was found in 2% of the samples, and cystitis glandularis was found in 0.4% of the samples. Von Brunn\u0026rsquo;s nests, follicular cystitis and adenomatous differentiation were observed in 0.1% of the patients. An incidental finding of schistosomiasis in TURBT samples for urothelial carcinoma was noted in 1.3% of the samples. We assessed the clinical characteristics by sex, and our study revealed no significant difference between the grade of tumors and NMIBC versus MIBC between males and females (p value\u0026thinsp;\u0026lt;\u0026thinsp;0.5).\u003c/p\u003e\n\u003cp\u003eAmong the RCs performed for UC, 87% of the samples had high-grade disease, and MIBC accounted for 77% of the samples. The remainder were for NMIBC, and only 12% of these were low-grade specimens. CIS was found in 15% of the RC samples. LVI was found in 37% of the samples in this group. Squamous differentiation was observed in 5% of the patients, glandular differentiation in 1%, and sarcomatoid features in 6% of the patients. Cystitis cystica was found in 4% of these cases, and cystitis glandularis was observed in 1% of the cases. Schistosomiasis was observed in 1% of the RC samples. With respect to the involvement of local structures, the prostate was involved in 15% of cases, the lymph nodes were positive in 29%, ureteric involvement was observed in 7%, and seminal vesicles were observed in 5% of cases. Carcinoma was upstaged from TURBT in 35% of the patients. Incidental prostate adenocarcinoma was found in 10% of patients in our current study, with Gleason 3\u0026thinsp;+\u0026thinsp;3 (WHO Grade Group 1) carcinomas being the predominant finding.\u003c/p\u003e\n\u003cp\u003eIn cases where multiple TURBTs were performed for the same patient or in cases where one patient progressed from TURBT to radical cystectomy, progression data were recorded. Our study revealed that all cases of CIS progressed. High-grade UC progressed in 30% of the patients, did not progress in 50%, and regressed in 19% of the patients. Low-grade UC progressed in 23% of the patients, did not progress in 56%, and regressed in 21%.\u003c/p\u003e\n\u003cp\u003eOur study revealed SCC in 7% of the patients. TURBTs accounted for 88% (N\u0026thinsp;=\u0026thinsp;58) of the cases in this group, whereas RC specimens accounted for 12% (N\u0026thinsp;=\u0026thinsp;8) of the cohort. The mean age at diagnosis for SCC patients was 52 years; males accounted for 41% (N\u0026thinsp;=\u0026thinsp;27) of the patients, whereas females accounted for 59% (N\u0026thinsp;=\u0026thinsp;39) of the patients. Schistosomiasis was present in 38% of the samples. The limited number of RCs included advanced-stage disease (T2b-12%, T3b-25%, and T4-62% of cases).\u003c/p\u003e\n\u003cp\u003ePrimary bladder adenocarcinoma was found in less than 2% of the specimens (N\u0026thinsp;=\u0026thinsp;13).\u003c/p\u003e\n\u003cp\u003eOther malignancies accounted for 2% of all cases and included spindle cell sarcoma, neuroendocrine tumors, rhabdomyosarcomas, lymphomas and clear cell carcinoma of the Mullerian type.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides valuable insights into the histopathological patterns of bladder cancer in Johannesburg, South Africa, and addresses a significant gap in the literature. Our findings indicate a predominance of bladder cancer diagnoses in male patients, which is consistent with previous studies reporting that bladder cancer is up to four times more common in males [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This gender disparity is often attributed to delayed diagnosis, differing help-seeking behaviors, and increased exposure to smoking and occupational hazards in males [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study confirms that UC is the most prevalent form of bladder cancer, which aligns with both international and limited African studies [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Historically, squamous cell carcinoma (SCC) has been the dominant histopathological subtype of bladder cancer in African countries because of the high incidences of schistosomiasis and schistosomal cystitis [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, with increasing urbanization and efforts to control schistosomiasis, the incidence of UC is increasing, particularly in nonendemic areas such as Johannesburg [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study also revealed a predominance of nonmuscle invasive bladder cancer (NMIBC), which is consistent with global trends, where 75\u0026ndash;80% of UC cases are reported as NMIBC [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Limited African data corroborate this finding, with NMIBC occurring in 75\u0026ndash;85% of cases [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A previous study from 1996 indicated that 76% of UC cases in South Africa were staged as T1 tumors, which mirrors our current findings [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Seventy-five percent of NMIBC cases are high-grade [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. High-grade tumors are associated with increased progression rates, necessitating specific risk stratification strategies for proper patient management [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Our study revealed that high-grade UC progressed in 30% of patients, with 23% of low-grade patients also showing progression. Furthermore, all cases of CIS progressed to either high-grade disease or required radical cystectomy.\u003c/p\u003e \u003cp\u003eThis study highlighted associations between certain pathological findings and clinical outcomes. Our study revealed CIS in 6% of TURBT patients, whereas the presence of CIS at TURBT has been reported with a wide incidence range of 24\u0026ndash;59% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This variability is likely due to sampling errors and the positioning of the CIS relative to the tumor, prompting some authors to advocate for random bladder sampling, enhanced cystoscopy, and urine cytology to increase the detection of the CIS [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Histopathological variants of UC, including squamous and glandular differentiation, micropapillary, plasmacytoid, sarcomatoid, and nested variants, have been reported in more than 25% of cases and are generally associated with a more aggressive clinical course. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In our study, squamous differentiation was observed in 8% of the TURBT samples and 5% of the RC samples. Squamous differentiation is linked to faster disease progression and higher recurrence rates; hence, rapid definitive treatment is recommended when it is detected [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Glandular differentiation, reported to occur in 18% of cases, is associated with poorer prognosis and was found in 1% of our radical cystectomy cohort [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRC was primarily performed for MIBC, with 87% of these specimens found to have high-grade disease. CIS at RCs is associated with higher recurrence rates, and our study revealed that the incidence of CIS at RCs was 15%, which is lower than that reported in the literature but higher than our TURBT findings [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Lymph node involvement, which was present in 29% of the patients in our study, remains a critical prognostic factor, with an increasing number of positive nodes correlated with increased recurrence risk [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Additionally, 35% of carcinoma cases at RCs are upstaged from the original TURBT, which has been associated with higher rates of additional lymph node involvement and impacts recurrence and overall survival [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIncidental prostate adenocarcinoma was found in 10% of cases, predominantly with a combined Gleason score of 6, which equates to WHO grade group 1. This aligns with reported rates of incidental prostate carcinoma at RCs, which range between 24% and 51% [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Most incidental prostate cancer cases are organ confined and clinically insignificant, possibly reflecting the high incidence of both cancers in an aging population [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBladder SCC accounted for nearly 7% of the cases, with most samples being TURBTs and very few RCs being performed. This is likely because 27% of patients present with advanced-stage disease at the outset, rendering many patients inoperable at diagnosis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. SCC is often muscle invasive and has an advanced stage of disease (T3/T4) at initial presentation, accounting for approximately 90% of cases [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Our study revealed that SCC patients were diagnosed at a younger age than UC patients were, which aligns with reported trends [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, we observed a female predominance (59%), whereas the literature typically reports a male predominance [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Schistosomiasis was detected in 38% of the SCC patients in our study, with reports in a limited number of African studies ranging from 45\u0026ndash;85% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. RC for SCC shows a predominance of higher-stage disease, which is consistent with the literature indicating that most SCC cases are muscle invasive at diagnosis, potentially due to differences in pathogenesis and tumor spread [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study revealed primary bladder adenocarcinoma in 1.5% of the samples. Primary bladder adenocarcinoma is staged higher than UC at diagnosis, with the involvement of local structures, which is consistent with the limited literature on this clinical entity [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Other malignancies were observed only in a small percentage of our cohort. Patients presenting with these malignancies often face challenges due to their aggressive nature and poor prognosis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Furthermore, treatment options for these malignancies are controversial and widely debated owing to the small number of guidelines and treatment algorithms. For such patients, the trend is toward early RC [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study evaluated the histopathological features of bladder cancer in Johannesburg Province over 13 years and revealed a predominance of high-grade NMIBC. RC performed for muscle-invasive disease revealed histologically advanced disease with significant lymph node involvement, likely due to the predominance of high-grade UC. Our study revealed low levels of SCC, possibly because Johannesburg is not an endemic bilharzia area, although the SCC cases observed in our study were found to have relatively high pathological stages. Importantly, despite Johannesburg not being endemic for bilharzia, referral patterns bring many nonlocal patients to our hospital seeking healthcare.\u003c/p\u003e \u003cp\u003eOur findings suggest a shift in bladder cancer trends in Africa away from SCC toward UC, influenced by urbanization and a high prevalence of smoking. The large cohort of patients in the NMIBC group reflects the high morbidity of bladder cancer, the likely high return of patients to the health care system repeatedly, high repeat procedure rates and risk of progression of their malignancy. Therefore, smoking, the greatest risk factor for bladder cancer, is increasing in the rapidly growing population. On the basis of this reported information, a better anti-smoking campaign and more effective prevention strategies are strongly recommended. Continued efforts toward the treatment and screening of Bilharzia are equally imperative owing to the advanced clinical presentation of these patients.\u003c/p\u003e"},{"header":"Strengths and weaknesses of the study","content":"\u003cp\u003eThe strengths of this study include its large number of urothelial carcinoma TURBT data. Weaknesses include the retrospective nature of the study as well as the lack of prospective data on the patients included.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJJ - carried out the research and data analysis and wrote the main manuscriptAA - supervisor of the research, study design and methods, edited the manuscriptRW - supervisor of the research, study design and methods, edited the manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to acknowledge NHLS for granting full access to the histopathological data reviewed in this research.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ehttps://www.uicc.org/news/globocan-2022-latest-global-cancer-data-shows-rising-incidence-and-stark-inequities.\u003c/li\u003e\n\u003cli\u003eCumberbatch MGK, Jubber I, Black PC, Esperto F, Figueroa JD, Kamat AM, et al. Epidemiology of Bladder Cancer: A Systematic Review and Contemporary Update of Risk Factors in 2018. Eur Urol. 2018 Dec;74(6):784\u0026ndash;95. https://doi.org/10.1016/j.eururo.2018.09.001\u003c/li\u003e\n\u003cli\u003eMari A, Campi R, Tellini R, Gandaglia G, Albisinni S, Abufaraj M, et al. Patterns and predictors of recurrence after open radical cystectomy for bladder cancer: a comprehensive review of the literature. World J Urol. 2018 Feb;36(2):157\u0026ndash;70. https://doi.org/10.1007/s00345-017-2115-4\u003c/li\u003e\n\u003cli\u003eCassell A, Yunusa B, Jalloh M, Mbodji MM, Diallo A, Ndoye M, et al. Non-Muscle Invasive Bladder Cancer: A Review of the Current Trend in Africa. World J Oncol. 2019;10(3):123\u0026ndash;31. https://doi.org/10.14740/wjon1210\u003c/li\u003e\n\u003cli\u003eAdeloye D, Harhay MO, Ayepola OO, Dos Santos JP, David RA, Ogunlana OO, et al. Estimate of the incidence of bladder cancer in Africa: A systematic review and Bayesian meta‐analysis. Int J Urol. 2019 Jan;26(1):102\u0026ndash;12. https://doi.org/10.1111/iju.13824\u003c/li\u003e\n\u003cli\u003ehttps://www.nicd.ac.za/wp-content/uploads/2024/04/NCR_ASR_tables_2022_final.pdf.\u003c/li\u003e\n\u003cli\u003eBowa K, Mulele C, Kachimba J, Manda E, Mapulanga V, Mukosai S. A review of bladder cancer in Sub-Saharan Africa: A different disease, with a distinct presentation, assessment, and treatment. Ann Afr Med. 2018;17(3):99. https://doi.org/10.4103/aam.aam_48_17\u003c/li\u003e\n\u003cli\u003eGroenewald P, Pacella R, Sitas F, Awotiwon OF, Vellios N, Van Rensburg CJ, et al. Estimating the changing disease burden attributable to smoking in South Africa for 2000, 2006 and 2012. S Afr Med J. 2022 Sep 30;649\u0026ndash;61. https://doi.org/10.7196/SAMJ.2022.v112i8b.16492\u003c/li\u003e\n\u003cli\u003ehttps://joburg.org.za/about_/Pages/About%20the%20City/About%20Joburg/Facts-about-Joburg.aspx.\u003c/li\u003e\n\u003cli\u003eMantica G, Terrone C, Der Merwe AV. Bladder Cancer and Associated Risk Factors: The African Panorama. Eur Urol. 2021 May;79(5):568\u0026ndash;70. https://doi.org/10.1016/j.eururo.2020.11.041\u003c/li\u003e\n\u003cli\u003eGroeneveld AE, Marszalek WW, Heyns CF. Bladder cancer in various population groups in the greater Durban area of KwaZulu‐Natal, South Africa. Br J Urol. 1996 Aug;78(2):205\u0026ndash;8. https://doi.org/10.1046/j.1464-410X.1996.09310.x\u003c/li\u003e\n\u003cli\u003eComp\u0026eacute;rat E, Oszwald A, Wasinger G, Hansel DE, Montironi R, Van Der Kwast T, et al. Updated pathology reporting standards for bladder cancer: biopsies, transurethral resections and radical cystectomies. World J Urol. 2022 Apr;40(4):915\u0026ndash;27. https://doi.org/10.1007/s00345-021-03831-1\u003c/li\u003e\n\u003cli\u003eSaouli A, Karmouni T, El Khader K, Koutani A, Andaloussi AIA. Histology of variants of urothelial carcinoma of the bladder: a Moroccan series of 39 cases. Afr J Urol. 2021 Dec;27(1):1. https://doi.org/10.1186/s12301-020-00106-w\u003c/li\u003e\n\u003cli\u003eZapała P, Dybowski B, Poletajew S, Białek Ł, Niewczas A, Radziszewski P. Clinical rationale and safety of restaging transurethral resection in indication-stratified patients with high-risk non-muscle-invasive bladder cancer. World J Surg Oncol. 2018 Dec;16(1):6. https://doi.org/10.1186/s12957-018-1310-0 \u003c/li\u003e\n\u003cli\u003eKryvenko ON, Epstein JI. Mimickers of urothelial neoplasia. Ann Diagn Pathol. 2019 Feb;38:11\u0026ndash;9. https://doi.org/10.1016/j.anndiagpath.2018.09.012\u003c/li\u003e\n\u003cli\u003eWu K, Liu X, Tang Y, Wang X, Li X. Clinicopathologic characteristics and outcomes of prostate cancer incidentally discovered at the time of radical cystoprostatectomy: a population-based cohort study. Int J Surg Lond Engl. 2024 Jul 1;110(7):4023\u0026ndash;30. https://doi.org/10.1097/JS9.0000000000001401\u003c/li\u003e\n\u003cli\u003ePignot G, Salomon L, Lebacle C, Neuzillet Y, Lunardi P, Rischmann P, et al. Prostate cancer incidence on cystoprostatectomy specimens is directly linked to age: results from a multicenter study. BJU Int. 2015 Jan;115(1):87\u0026ndash;93. https://doi.org/10.1111/bju.12803\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Bladder cancer, Urothelial carcinoma, Histopathology, Johannesburg, Squamous cell carcinoma, Non-muscle invasive bladder cancer, Muscle-invasive bladder cancer","lastPublishedDoi":"10.21203/rs.3.rs-5397979/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5397979/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo evaluate the histopathological characteristics of bladder cancer in patients presenting to Johannesburg hospitals over a 13-year period (2010\u0026ndash;2023).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eFollowing ethical clearance, a retrospective study of 1480 histopathological reports was done. Normality of distribution was tested using the Shapiro Wilk test. Histopathological results were compared by patient gender using the Fisher's exact, and by age, using either one-way ANOVA or the Kruskal-Wallis test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eUrothelial carcinoma accounted for 88.8% of bladder cancer cases, squamous cell carcinoma (7.7%), adenocarcinoma (1.5%), and other malignancies (2%). High-grade urothelial carcinoma was the predominant subtype, accounting for 75% of cases. Non-muscle invasive disease accounted for 72% of these cases, while 28% were muscle invasive. Data from radical cystectomies showed a high proportion of aggressive and advanced disease.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe study highlights the predominance of high-grade non-muscle invasive bladder cancer in Johannesburg, consistent with global trends. However, the presence of advanced disease at diagnosis, particularly in cases needing radical cystectomy for urothelial carcinoma, and squamous cell carcinoma, reflects the ongoing challenges in early detection and treatment in this population. The findings suggest a shift in bladder cancer trends in Africa away from assumed squamous cell carcinoma towards urothelial carcinoma, possibly influenced by increasing urbanisation, smoking and changes in risk factor profiles.\u003c/p\u003e","manuscriptTitle":"A Histopathological Snapshot of Bladder Cancer: a Johannesburg Experience of 1480 Histopathology Reports","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-29 06:14:50","doi":"10.21203/rs.3.rs-5397979/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-31T08:46:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-15T16:02:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261474408578783666549102655237963791836","date":"2024-12-12T00:09:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-26T09:43:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"226143959793431662095249800780335928926","date":"2024-11-26T09:10:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-21T10:45:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-12T12:33:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-12T12:03:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Urology","date":"2024-11-05T20:27:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"793d5ff1-867a-43b5-aedc-adeecf8e64e4","owner":[],"postedDate":"November 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-17T16:08:01+00:00","versionOfRecord":{"articleIdentity":"rs-5397979","link":"https://doi.org/10.1007/s00345-025-05540-5","journal":{"identity":"world-journal-of-urology","isVorOnly":false,"title":"World Journal of Urology"},"publishedOn":"2025-03-11 15:58:32","publishedOnDateReadable":"March 11th, 2025"},"versionCreatedAt":"2024-11-29 06:14:50","video":"","vorDoi":"10.1007/s00345-025-05540-5","vorDoiUrl":"https://doi.org/10.1007/s00345-025-05540-5","workflowStages":[]},"version":"v1","identity":"rs-5397979","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5397979","identity":"rs-5397979","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}