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| Uncovering the epidemiology of bladder cancer in the Arab world: A review of risk factors, molecular mechanisms, and clinical features |
Noura F. Abbasa,*( ),Marc R. Aoudea,Hampig R. Kouriea,Humaid O. Al-Shamsib,c,d,e,f
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aDepartment of Hematology-Oncology, Hotel Dieu De France Hospital, Saint Joseph University of Beirut, Riad El Solh, Lebanon
bDepartment of Oncology, Burjeel Cancer Institute, Burjeel Medical City, Abu Dhabi, United Arab Emirates
cInnovation and Research Center, Burjeel Cancer Institute, Burjeel Medical City, Abu Dhabi, United Arab Emirates
dCollege of Medicine, University of Sharjah, Sharjah, United Arab Emirates
eEmirates Oncology Society, Dubai, United Arab Emirates
fCollege of Medicine, Gulf Medical University, Ajman, United Arab Emirates |
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Abstract Objective: Bladder cancer (BC) is a significant public health concern in the Middle East and North Africa, but the epidemiology and clinicopathology of the disease and contributors to high mortality in this region remain poorly understood. The aim of this systematic review was to investigate the epidemiological features of BC in the Arab world and compare them to those in Western countries in order to improve the management of this disease. Methods: An extensive electronic search of the PubMed/PMC and Cochrane Library databases was conducted to identify all articles published until May 2022, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A total of 95 articles were included in the final analysis after title, abstract, and full-text screening, with additional data obtained from the GLOBOCAN and WHO 2020 databases. Results: Most of the included articles were case-control studies examining the risk factors and molecular mechanisms of BC. These studies originated from 10 different countries, with Egypt being the most active contributor. While BC in the Arab world shares some common risk factors with Western countries, such as smoking and occupational exposure, it also exhibits unique features related to schistosomiasis. The high mortality rates in this region are alarming and can be attributed to various factors, including the prevalence of smoking, the impact of schistosomiasis, a combination of genetic and socioeconomic factors, treatment shortages, and limited access to care or inadequate assessment of the quality of care. Conclusion: Despite the relatively low incidence of BC in Arab countries, the mortality rates are among the highest worldwide. BC tends to be more aggressive in the Arab world, making it essential to implement strategies to address this burden.
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Received: 31 December 2022
Available online: 20 July 2024
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Corresponding Authors:
*E-mail address: noura.abbas@hotmail.com (N.F. Abbas).
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Preferred Reporting Items for Systematic reviews and Meta-Analyses flowchart for the article selection process. BC, bladder cancer.
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| Study | Country | Sample size, n | Age, mean, year | M:F, ratio | Smokinga | Bilharziasisa | Histological typea | TNM staginga | WHO gradea,b | | TCC | SCC | Others | Ta-T1 | T2 | T3 | T4 | N+ | M1 | I | II | III | LG | HG | | El-Boulkany et al., 1972 [65] | Egypt | 304 | 46.3 | 4.0:1 | NA | NA | 54 (23.4)c | 152 (66.7)c | 23 (9.9)c | NA | 37 (27.4)c | 96 (71.1)c | 2 (1.5)c | 34 (14.8)c | 29 (12.8)c | 79 (34.6)c | 89 (38.7)c | 61 (26.5)c | NA | NA | | Zaghloul et al., 1992 [110] | Egypt | 236 | 48.1 | 4.7:1 | NA | 236 (100) | 49 (21.0)c | 158 (67.5)c | 27 (11.5)c | 0 (0) | 0 (0) | 236 (100) | 0 (0) | 55 (23.3) | NA | 62 (26.3) | 86 (36.4) | 88 (37.3) | NA | NA | | Attallah et al., 1996 [111] | Egypt | 118 | NA | NA | NA | NA | 33 (28.0) | 71(60.2) | 14 (11.8) | NA | NA | NA | NA | NA | NA | 18 (37.5)c | 22 (45.8)c | 8 (16.7)c | NA | NA | | Tamimi et al., 1996 [63] | Egypt | 45 | NA | NA | NA | 45 (100) | 20 (44.4) | 20 (44.4) | 5 (0.1) | 6 (13.3) | 39 (86.7)d | NA | NA | 12 (26.7) | 25 (55.6) | 8 (17.7) | NA | NA | | Ali-el-Dein et al., 1997 [112] | Egypt | 253 | NA | 4.4:1 | NA | 95 (37.5) | 253 (100) | NA | NA | 253 (100) | 0 (0) | 0 (0) | 0 (0) | NA | NA | 39 (15.4) | 179 (70.8) | 35 (13.8) | NA | NA | | Shaw et al., 1999 [59] | Egypt | 66 | NA | NA | NA | 66 (100) | 13 (19.7) | 44 (66.7) | 9 (13.6) | 9 (13.6) | 57 (86.4)d | NA | NA | NA | NA | NA | NA | NA | | Aly and Khaled, 1999 [60] | Egypt | 31 | 56.0 | 2.8:1 | NA | 17 (70.8)c | 13 (41.9) | 17 (54.8) | 1 (3.2) | 0 (0) | 1 (3.4)c | 25 (86.2)c | 3 (10.3)c | 7 (25.0)c | NA | NA | NA | NA | NA | NA | | Khaled et al., 2000 [61] | Egypt | 25 | 60.0 | 2.1:1 | NA | 14 (70.0)c | 9 (36.0) | 16 (64.0) | 0 (0) | 0 (0) | 1 (4.3)c | 19 (82.6)c | 3 (13.0)c | 4 (18.2)c | NA | 2 (8.0) | 17 (6.0) | 6 (24.0) | NA | NA | | Aly and Khaled, 2002 [62] | Egypt | 35 | 56.0 | 3.4:1 | NA | 11 (34.4)c | 24 (68.6) | 11 (31.4) | 0 (0) | 24 (70.6)c | 10 (29.4)c | 0 (0) | 0 (0) | NA | NA | 11 (31.4) | 21 (60.0) | 3 (8.6) | NA | NA | | Khaled et al., 2003 [113] | Egypt | 99 | 55.0 | 2.6:1 | NA | 77 (81.9)c | 41 (44.6)c | 49 (53.2)c | 2 (2.2)c | 1 (1.0) | 2 (2.0) | 96 (97.0) | 0 (0) | 13 (13.7)c | NA | 12 (12.1) | 62 (62.6) | 25 (25.3) | NA | NA | | Ali-El-Dein et al., 2003 [114] | Egypt | 533 | 55.4 | 3.6:1 | NA | NA | 533 (100) | 0 (0) | 0 (0) | 533 (100) | 0 (0) | 0 (0) | 0 (0) | NA | NA | 80 (15.0) | 342 (64.2) | 111 (20.8) | NA | NA | | Aly and Khaled, 2004 [90] | Egypt | 40 | 51.0 | 3.0:1 | NA | 29 (78.4)c | 16 (40.0) | 21 (52.5) | 3 (7.5) | 1 (2.7)c | 5 (13.5)c | 31 (83.8)c | NA | 12 (34.3)c | NA | 5 (12.8)c | 21 (53.9)c | 13 (33.3)c | NA | NA | | Khaled et al., 2005 [79] | Egypt | 180 | NA | 3.6:1 | NA | 129 (79.7)c | 70 (38.9) | 96 (53.3) | 14 (7.8) | 2 (1.2)c | 10 (5.8)c | 141 (81.5)c | 20 (11.5)c | 28 (16.6)c | NA | 20 (11.1) | 110 (61.1) | 50 (27.8) | NA | NA | | Helal et al., 2006 [80] | Egypt | 114 | 50.8 | 8.5:1 | NA | 64 (56.1) | 67 (58.8) | 32 (28.0) | 15 (13.2) | 20 (17.5) | 94 (82.5)d | NA | NA | NA | NA | NA | NA | NA | | Khafagy et al., 2006 [115] | Egypt | 60 | 50.5 | 11.0:1 | NA | 38 (63.3) | 18 (30.0) | 35 (58.3) | 7 (11.7) | 2 (3.3) | 3 (5.0) | 29 (48.3) | 26 (43.4) | 8 (13.3) | 2 (3.3) | 4 (6.7) | 47 (78.3) | 9 (15.0) | NA | NA | | Badawi et al., 2008 [116] | Egypt | 36 | NA | NA | NA | NA | 25 (69.4) | 4 (11.1) | 7 (19.4) | 22 (61.1) | 14 (38.9)e | NA | NA | NA | NA | NA | NA | 27 (75.0) | 9 (25.0) | | Zarzour et al., 2008 [35] | Egypt | 130 | 58.3 | 5.2:1 | 104 (80.0) | 114 (87.7) | 20 (15.4) | 88 (67.6) | 22 (17.0) | 0 (0) | NA (56.3)c | NA (10.9)c | NA (32.8)c | NA (13.3)c | NA | NA | NA | NA | NA | NA | | Osman et al., 2009 [117] | Egypt | 60 | 57.2 | 2.2:1 | NA | NA | 14 (23.3) | 37 (61.7) | 9 (15.0) | 37 (61.7)f | 19 (31.7) | 4 (6.6) | 8 (13.3) | NA | 13 (21.7) | 10 (16.7) | 37 (61.6) | NA | NA | | Mahmoud et al., 2010 [89] | Egypt | 51 | NA | 3.6:1 | 29 (56.9) | 25 (49.0) | 39 (76.5) | 11 (21.6) | 1 (1.9) | 17 (33.3) | 34 (66.7)d | NA | NA | NA | NA | NA | 25 (49.0) | 26 (51.0) | | Zaghloul et al., 2010 [118] | Egypt | 40 | 54.0 | 3.4:1 | NA | NA | 25 (62.5) | 14 (35.0) | 1 (2.5) | NA | NA | NA | NA | NA | 40 (100) | NA | NA | NA | NA | NA | | Goerlitz et al., 2011 [119] | Egypt | 625 | NA | 4.1:1 | 383 (76.1)c | 306 (52.7)c | 389 (62.2) | 236 (37.8) | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | | Salem and Mahfouz, 2012 [30] | Egypt | 1932 | 46.3 | 4.9:1 | NA (56.5) | NA (65.6) | NA (42.1) | NA (49.9) | NA (8.0) | NA (3.0) | NA (17.4) | NA (72.6) | NA (7.0) | NA (36.4) | NA | NA | NA | NA | NA (31.9) | NA (68.1) | | Salama et al., 2012 [87] | Egypt | 65 | NA | NA | NA | NA | 32 (49.2) | 29 (44.6) | 4 (6.2) | 11 (16.9) | 10 (15.4) | 38 (58.5) | 6 (9.2) | 9 (13.9) | NA | 15 (23.1) | 24 (36.9) | 26 (40.0) | NA | NA | | Shams et al., 2013 [64] | Egypt | 120 | 49.6 | 4.0:1 | NA | 84 (70.0) | NA | 120 (100) | NA | 4 (3.3) | 74 (61.7) | 26 (21.7) | 16 (13.3) | 44 (36.7) | 8 (6.7) | 6 (5.0) | 62 (51.7) | 52 (43.3) | NA | NA | | El-Monim et al., 2013 [120] | Egypt | 100 | 54.9 | 2.3:1 | NA | NA | 51 (51.0) | 46 (46.0) | 3 (3.0) | 0 (0) | 11 (11.0) | 85 (85.0) | 4 (4.0) | 14 (17.1)c | NA | NA | NA | NA | 83 (83.0) | 17 (17.0) | | El-Sharkawi et al., 2014 [74] | Egypt | 70 | 61.3 | 2.9:1 | NA | 36 (51.4) | NA | NA | NA | 33 (47.1)f | 37 (52.9)g | NA | NA | NA | NA | NA | NA | NA | | Harraz et al., 2014 [121] | Egypt | 102 | 52.9 | 5.4:1 | NA | NA | 62 (60.8) | 25 (24.5) | 15 (14.7) | 17 (16.7) | 49 (48.1) | 34 (33.3) | 2 (2.0) | 15 (14.7) | NA | NA | NA | NA | NA | NA | | Khaled et al., 2014 [122] | Egypt | 114 | 55.3 | 3.6:1 | NA | NA | 50 (43.9) | 59 (51.7) | 5 (4.4) | 0 (0) | 2 (1.8) | 82 (71.9) | 30 (26.3) | 11 (9.6) | NA | 18 (16.1)c | 65 (58.0)c | 29 (25.9)c | NA | NA | | Haggag et al., 2014 [123] | Egypt | 120 | 61.0 | 3.3:1 | NA | NA | 87 (72.5) | 28 (23.3) | 5 (4.2) | NA | NA | NA | NA | 21 (17.5) | 45 (37.5) | NA | NA | NA | NA | NA | | Wang et al., 2015 [57] | Egypt | 224 | 61.3 | 6.5:1 | 175 (78.1) | NA | 224 (100) | 0 (0) | 0 (0) | 53 (31.4)c | 116 (68.6)c,d | NA | NA | NA | NA | NA | NA | NA | | Spradling et al., 2016 [78] | Egypt | 879 | 54.0 | 3.7:1 | NA | 557 (63.4) | 519 (59.0) | 360 (41.0) | 0 (0) | 137 (15.6) | 337 (38.3) | 336 (38.2) | 69 (7.8) | 288 (32.8) | 137 (15.6) | NA | NA | NA | 225 (25.6) | 654 (74.4) | | Martin et al., 2018 [95] | Egypt | 1238 | 54.0 | 3.7:1 | NA | 802 (64.8) | 751 (60.7) | 398 (32.1) | 89 (7.2) | 175 (14.1) | 480 (38.8) | 469 (37.9) | 114 (9.2) | 341 (27.6) | NA | NA | NA | NA | 272 (22.0)c | 848 (68.0)c | | Owyong et al., 2019 [82] | Egypt | 151 | 51.8 | 1.8:1 | NA | 122 (80.8) | 0 (0) | 151 (100) | 0 (0) | 10 (6.6) | 75 (49.7) | 57 (37.7) | 9 (6.0) | 46 (30.5) | NA | NA | NA | NA | 80 (53.0) | 71 (47.0) | | Harraz et al., 2019 [124] | Egypt | 74 | 61.8 | 9.6:1 | 47 (63.5) | NA | 74 (100) | 0 (0) | 0 (0) | 48 (64.8) | 7 (9.5) | 19 (25.7) | 0 (0) | 1 (16.7)c | NA | NA | NA | NA | NA | NA | | Al-Sharaky et al., 2020 [92] | Egypt | 80 | 62.0 | 9.0:1 | NA | 26 (32.5) | 72 (90.0) | 5 (6.2) | 3 (3.7) | NA | NA | NA | NA | 25 (50.0)c | NA | NA | NA | NA | 18 (22.5) | 62 (77.5) | | Esawy et al., 2020 [88] | Egypt | 75 | 63.0 | 5.3:1 | NA | NA | NA | NA | NA | 34 (45.3) | 16 (21.4) | 7 (9.3) | 18 (24.0) | NA | NA | 16 (21.3) | 42 (56.0) | 17 (22.7) | NA | NA | | Ben Selma et al., 2010 [125] | Tunisia | 125 | 70.0 | 6.8:1 | 75 (60.0) | NA | 119 (95.2) | 5 (4.0) | 1 (0.8) | 70 (58.8)c | 28 (23.5)c | 17 (14.3)c | 4 (3.4)c | NA | NA | 37 (31.1)c | 49 (41.2)c | 33 (27.7)c | NA | NA | | Rouissi et al., 2011 [44] | Tunisia | 193 | 65.2 | 10.4:1 | 154 (79.8) | NA | 193 (100) | 0 (0) | 0 (0) | 149 (77.2) | 44 (22.8)d | NA | NA | NA | NA | NA | NA | NA | | Ben Wafi et al., 2018 [52] | Tunisia | 218 | 64.8 | 5.6:1 | 176 (80.7) | NA | 218 (100) | 0 (0) | 0 (0) | 146 (67.0) | 72 (33.0)d | NA | NA | 76 (34.9) | 73 (33.5) | 69 (31.6) | NA | NA | | Hadami et al., 2018 [126] | Morocco | 30 | 65.0 | 6.5:1 | NA | NA | NA | NA | NA | 22 (73.3) | 8 (26.7) | 0 (0) | 0 (0) | NA | NA | NA | NA | NA | 12 (40.0) | 18 (60.0) | | Saheb Sharif-Askari et al., 2018 [68] | Libya | 835 | 63.7 | 8.8:1 | 594 (71.1) | NA | 730 (87.4) | 74 (8.9) | 31 (3.7) | NA | NA | NA | NA | NA | NA | NA | NA | NA | 696 (83.4) | 139 (16.6) | | Nedjadi et al., 2016 [91] | Saudi Arabia | 160 | 60.0 | 4.9:1 | NA | NA | 160 (100) | 0 (0) | 0 (0) | NA | NA | NA | NA | 18 (17.3)c | 17 (17.0)c | NA | NA | NA | 68 (44.4)c | 85 (55.6)c | | El-Siddig et al., 2017 [66] | Saudi Arabia | 116 | 62.4 | 4.8:1 | NA | NA | 111 (95.7) | 2 (1.7) | 3 (2.6) | 78 (70.5)c | 33 (29.5)c,d | NA | NA | NA | NA | NA | 72 (65.0)c | 39 (35.0)c | | Mokhtar et al., 2017 [77] | Saudi Arabia | 328 | 58.0 | 4.5:1 | NA | 80 (24.4) | 235 (71.7) | 79 (24.1) | 14 (4.2) | 29 (8.8) | 91 (27.7) | 159 (48.5) | 49 (14.9) | 82 (25.0) | NA | NA | NA | NA | 11 (2.3) | 317 (96.7) | | Al-Maghrabi et al., 2019 [83] | Saudi Arabia | 123 | 65.0 | 4.9:1 | NA | NA | 123 (100) | 0 (0) | 0 (0) | 46 (37.4) | 47 (38.2) | 17 (13.8) | 13 (10.6) | 25 (20.3) | 13 (10.6) | NA | NA | NA | 31 (25.2) | 92 (74.8) | | Al-Maghrabi, 2019 [85] | Saudi Arabia | 122 | 65.0 | 4.8:1 | NA | NA | 122 (100) | 0 (0) | 0 (0) | 59 (48.4) | 44 (36.1) | 8 (6.6) | 11 (9.0) | 24 (19.7) | 13 (10.7) | NA | NA | NA | 32 (26.2) | 90 (73.8) | | Alghafees et al., 2022 [67] | Saudi Arabia | 3750 | 62.3 | 4.6:1 | NA | NA | 3371 (89.9) | 208 (5.5) | 171 (4.6) | NA | NA | NA | NA | 185 (4.9) | 448 (11.9) | 406 (13.1)c | 796 (25.7)c | 1898 (61.2)c | NA | NA | | Kobeissi et al., 2013 [50] | Lebanon | 54 | 67.1 | All males | NA | NA | 50 (94.3)c | NA | 1 (1.9)c | NA | NA | NA | NA | NA | NA | NA | NA | NA | 26 (51.0)c | 25 (49.0)c | | Labban et al., 2021 [93] | Lebanon | 37 | 72.1 | 6.4:1 | 16 (66.7)c | NA | 37 (100) | 0 (0) | 0 (0) | 0 (0) | 13 (48.1)c | 14 (51.9)c,g | 25 (67.6) | 31 (83.8) | NA | NA | NA | NA | NA | | Matalka et al., 2008 [105] | Jordan | 110 | 60.6 | 9.0:1 | NA | NA | 110 (100) | 0 (0) | 0 (0) | 79 (71.8) | 22 (20.0) | 8 (7.3) | 1 (0.9) | NA | 2 (1.8) | NA | NA | NA | 66 (60.0) | 44 (40.0) | | Bodoor et al., 2010 [94] | Jordan | 121 | 63.0 | 7.1:1 | 92 (76.0) | NA | 121 (100) | 0 (0) | 0 (0) | 93 (76.9) | 24 (19.8) | 4 (3.3) | NA | NA | NA | 54 (44.6) | 32 (26.4) | 35 (28.9) | NA | NA | | Bani-Hani et al., 2022 [127] | Jordan | 119 | 61.1 | 12.2:1 | 99 (83.2) | NA | 119 (100) | 0 (0) | 0 (0) | 119 (100) | 0 (0) | 0 (0) | 0 (0) | NA | NA | NA | NA | NA | 77 (64.7) | 42 (35.3) | | Al-Abbasi et al., 2009 [53] | Iraq | 54 | 65.5 | 3.2:1 | NA | NA | 54 (100) | 0 (0) | 0 (0) | 18 (33.3) | 9 (16.7) | 12 (22.2) | 15 (27.8) | NA | NA | 11 (20.4) | 23 (42.6) | 20 (37.0) | NA | NA | | Avitan et al., 2017 [97] | Palestine | 68 | 62.6 | 5.8:1 | NA | NA | 63 (92.6) | NA | NA | 51 (75.0) | 17 (25.0)d | NA | 5 (7.4) | NA | NA | NA | 27 (39.7) | 41 (60.3) |
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Epidemiological data about bladder cancer in North Africa and Western Asia.
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| Study | Country | BC type | Biomarker and gene | Finding | | Abul-Fadl and Metwalli, 1963 [69] | Egypt | BBC | Urinary β-glucuronidase; | ? Increased in BC
-5 folds (urinary β-glucuronidase)
? Decreased in BC
-10% (urinary acid phosphatase) | | urinary acid phosphatase | | Khalafallah and Abul-Fadl, 1964 [70] | Egypt | BBC | Tryptophan metabolites: | ? Increased in BC
-8 folds (3-hydroxyanthranilic acid)
-6 folds (anthranilic acid)
? Decreased in BC
-50% (kynurenic acid)
-50% (xanthurenic acid) | | 3-hydroxyanthranilic acid, anthranilic acid, kynurenic acid, and xanthurenic acid | | El-Sewedy et al., 1978 [72] | Egypt | BBC | Urinary α-esterases | ? Increased in BC (p<0.001); diagnostic accuracy of 95.9% | | Tricker et al., 1989 [71] | Egypt | BBC | Urinary nitrate, nitrite, and N-nitroso-compounds | ? Increased in BC | | El-Sharkawi et al., 2014 [74] | Egypt | NA | Urinary MMP-3 and urinary MMP-9 | ? Increased in BC
- early and late stage (urinary MMP-3)
- late stage only (urinary MMP-9)
? Diagnostic accuracy of about 94% (excluding early-stage MMP-9) | | Salama et al., 2012 [87] | Egypt | NA | NMP22, E-cadherin,
cathepsin D | ? Increased in BC
? Correlated to recurrence (NMP22 and E-cadherin) | | Kapila et al., 2008 [75] | Kuwait | NA | NMP22 (with urine cytology) | ? Increased sensitivity (to 96%) but decreased specificity (to 30%) | | Ismail et al., 2016 [76] | Egypt | NA | mRNA-S100A genes (with urine cytology) | ? Increased sensitivity (to 87%-96%) | | Esawy et al., 2020 [88] | Egypt | NA | Serum irisin | ? Decreased in BC (p<0.001); negative correlation with mortality and stage (p<0.001) | | Mahmoud et al., 2010 [89] | Egypt | NA | Serum interleukin-8 | ? Increased in BC (p<0.0001); sensitivity 71%, specificity 98% for a cut-off of 35 pg/mL; invasiveness (p<0.01) | | Warren et al., 1995 [54] | Egypt | BBC | p53 mutation | ? Increased CpG dinucleotide transitions | | Osman et al., 1997 [81] | Egypt | BBC | p53 mutation | ? Invasiveness, LNI (p<0.04) | | Khaled et al., 2003 [113] | Egypt | BBC | p53 mutation | ? High stage and grade (p<0.0001) | | Helal et al., 2006 [80] | Egypt | BBC | p53 mutation | ? High grade (p=0.03) | | Owyong et al., 2019 [82] | Egypt | SCC | PD-L1 negative | ? High stage (p=0.04) and grade (p=0.01), LNI (p<0.01), and recurrence (p=0.03) | | Moussa et al., 2009 [84] | Egypt | NA | COX2 | ? Increased in BC | | Al-Maghrabi et al., 2019 [83] | Saudi Arabia | TCC | COX2 | ? High grade (p<0.001) and LNI (p=0.011) | | Al-Maghrabi, 2019 [85] | Saudi Arabia | TCC | SIRT1 | ? Local recurrence and poor survival | | Aboushousha et al., 2020 [86] | Egypt | TCC | STAT3 | ? High grade and muscle-invasiveness | | Aly and Khaled, 2004 [90] | Egypt | BBC | HER2 | ? High grade (p=0.01) | | Nedjadi et al., 2016 [91] | Saudi Arabia | TCC | HER2 | ? High stage (p=0.002) and LNI (p<0.04) | | Al-Sharaky et al., 2020 [92] | Egypt | NA | ROC1, P21, and CAIX | ? Invasiveness and high grade | | Labban et al., 2021 [93] | Lebanon | NA | Coexpression of GATA3 and cytokeratin 5/6 or 14 | ? Reduced progression-free survival compared to GATA3 alone | | Bodoor et al., 2010 [94] | Jordan | NA | FGF23 | ? Good prognosis, low stage and grade |
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Biomarkers and genes found in BC and their potential clinical utility.
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Estimated age-standardized rates per 100 000 of bladder cancer in the Arab world, in 2020, for both sexes and all ages. (A) Incidence; (B) Mortality. Data obtained from GLOBOCAN 2020 [19].
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| Arab country | Prevalence of tobacco smokinga, % | Tobacco smoking ranking worldwidea | BC incidence ranking in the Arab world | BC mortality ranking in the Arab world | HDI | | Algeria | 21.0 | #75 | #7 | #4 | 0.736 (H) | | Bahrain | 14.9 | #99 | #10 | #15 | 0.877 (VH) | | Comoros | 20.3 | #78 | #14 | #9 | 0.562 (M) | | Djibouti | NA | NA | #19 | #21 | 0.510 (L) | | Egypt | 24.3 | #50 | #1 | #1 | 0.734 (H) | | Iraq | 18.5 | #86 | #11 | #8 | 0.679 (M) | | Jordan | 34.8 | #14 | #4 | #7 | 0.723 (H) | | Kuwait | 17.9 | #88 | #13 | #16 | 0.822 (VH) | | Lebanon | 38.2 | #7 | #5 | #6 | 0.726 (H) | | Libya | NA | NA | #6 | #3 | 0.703 (H) | | Mauritania | 10.7 | #127 | #20 | #22 | 0.556 (M) | | Morocco | 14.5 | #100 | #12 | #11 | 0.679 (M) | | Oman | 8.0 | #144 | #15 | #12 | 0.827 (VH) | | Palestine | 21.2 | #72 | #2 | #10 | 0.716 (H) | | Qatar | 11.8 | #119 | #16 | #13 | 0.854 (VH) | | Saudi Arabia | 14.3 | #105 | #17 | #20 | 0.870 (VH) | | Somalia | NA | NA | #18 | #17 | NA | | Sudan | NA | NA | #21 | #18 | 0.510 (L) | | Syria | NA | NA | #8 | #5 | 0.577 (M) | | Tunisia | 24.6 | #48 | #3 | #2 | 0.737 (H) | | United Arab Emirates | NA | NA | #9 | #14 | 0.912 (VH) | | Yemen | 20.3 | #80 | #22 | #19 | 0.460 (L) |
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Prevalence and ranking of tobacco smoking, BC incidence and mortality, and HDI in the Arab World in 2020 [106,128].
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| WHO region | Number of individuals receiving PC for schistosomiasis | | Africa | 211 470 992 | | Eastern Mediterranean | 20 582 722 | | Western Pacific | 2 939 845 | | Americas (South America) | 1 620 830 | | South-East Asia | 21 815 | | Europe | Not applicable | | Global | 236 636 204 |
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Global distribution of schistosomiasis endemicity in the different WHO regions, according to the WHO 2020 [20].
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| Arab country | Schistosomiasis endemicity status | | Egypta | Endemic, requiring PC | | Somalia | Endemic, requiring PC | | Mauritania | Endemic, requiring PC | | Sudan | Endemic, requiring PC | | Yemen | Endemic, requiring PC | | Libyaa | Status of transmission to be determined | | Syria | Status of transmission to be determined | | Iraqa | Status of transmission to be determined | | Oman | Status of transmission to be determined | | Tunisiaa | Interruption of transmission to be confirmed | | Jordana | Interruption of transmission to be confirmed | | Lebanona | Interruption of transmission to be confirmed | | Moroccoa | Interruption of transmission to be confirmed | | Djiboutia | Interruption of transmission to be confirmed | | Algeria | No PC required | | Saudi Arabiaa | No PC required | | Palestinea | Non-endemic | | United Arab Emirates | Non-endemic | | Bahrain | Non-endemic | | Kuwaita | Non-endemic | | Comoros | Non-endemic | | Qatar | Non-endemic |
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Regional distribution of schistosomiasis endemic countries in the Arab world, according to the WHO 2020 [20].
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