G. J. O. 2007; 1(2) 41 Wright et al (7) reported upon 1525 urinary bladder adenocarcinoma included in Surveillance, Epidemiology and End Results (SEER) Program of USA from the year 1973 to 2002. Out of these,1374 (90.1%) had non- urachal adenocarcinoma. The non-urachal patients enjoyed a 5-year survival rate of 35%. The working prognostic factors in this study were pathological stage, grade and type (urachal versus non-urachal). It is worth noting that the analysis did not include pelvic nodal involvement as 51% of the patient in this study did not undergo pelvic lymphadenectomy. The largest two single institution adenocarcinoma series determined the Prognostic Index for Primary Adenocarcinoma of the Urinary Bladder Mohamed S.Zaghloul *# , Manal El Baradie * , Akram Nouh ^# , Shorweif Abdel-Fatah *# , Azza Taher * and Mohamed Shalaan ** Radiation Oncology * Pathology^ and Surgical Oncology** Departments, National Cancer Institute, Cairo and Minia Oncology Center, Minia, # Egypt. Corresponding author: Mohamed Saad Zaghloul, MD, Prof., Radiation Oncology, National cancer Institute, Fom El Khalig, Cairo Tel : 20 101720664- 20 2 4143649 Fax : 20 2 3644720 E mail : mszagh@yahoo.com Home address: 8, Mohamed Bayoumy Street, Golfland, Heliopolis, Cairo, Egypt. Abstract Aim To determine the working independent prognostic factors and the prognostic index of adenocarcinoma of the urinary bladder. The effect of adding postoperative radiotherapy to radical cystectomy on this prognostic index was also investigated. Patients and Methods Two hundred and sixteen patients having adenocarcinoma of the urinary bladder were treated with radical cystectomy and pelvic lymphadenectomy with (82 patients) or without (134) postoperative radiotherapy. Postoperative radiotherapy (PORT) was given to the whole pelvis in a dose of 50 Gy /25 fractions over 5 weeks, and started 4-10 weeks after surgery. Results The 5-year disease-free survival rate was 44 ± 4% for the whole group. Postoperative radiotherapy improved the disease-free survival significantly from 33 ± 6% for cystectomy alone to 58 ± 6% for PORT patients (P=0.002). The independent prognostic factors for DFS were the pathological stage, histological subtypes, nodal involvement and the addition of postoperative radiotherapy. The stratification of patients using prognostic indices according to the pathological findings produces identifiable prognostic groups. Postoperative radiotherapy improved the DFS significantly in the intermediate and high risk indices (p=0.0004 and 0.0002 respectively). Conclusions The identified prognostic indices with their prognostic group could be used not only as a predictor of disease-free survival but also as a good predictor for the needs to add adjuvant therapy in adenocarcinoma of the urinary bladder. Key words : Adenocarcinoma, Bladder cancer, , postoperative radiotherapy, prognostic factors, treatment end-results. Introduction Primary adenocarcinoma of the urinary bladder is a rare entity representing 0.5-2% of all bladder cancer malignancy (1) . It is more frequently encountered in areas endemic for bilharziasis. The incidence ranged between 5.2% and 11.4% (2-5) . It is believed that these tumors result from metaplastic changes of potentially unstable urothelium (6) .