Risk Factors, Therapy and Survival Outcomes of Small Cell and Large Cell Neuroendocrine Carcinoma of Urinary Bladder

Abstract

The risk factors, the optimal therapy and prognostic factors contributing to poor outcomes of neuroendocrine urinary bladder carcinoma are not fully elucidated because of its rarity. We reviewed the medical records of neuroendocrine bladder carcinoma patients treated at the University of Nebraska Medical Center between 1996 and 2011. Eighteen patients, 55% female with a median age of 77 years, had stage IV disease at diagnosis in 50% of cases. There was a high prevalence of smoking (78%), medical co-morbidities (94%), prior cancer history (22%) and family history of cancer (61%). Treatment modalities included surgery (72%), platinum-based chemotherapy (50%) and/or radiation (22%). Median overall survival was 18.5 months (95% confidence interval, 7-36 months). Patients with Stage II and III cancer who underwent radical surgery with or without neoadjuvant chemotherapy had a median survival of 37 months. In addition to smoking, for the first time, our study indicates that the personal or family history of cancer may increase risk to neuroendocrine bladder cancer. Advanced age and stage at diagnosis, and the presence of multiple co-morbidities contribute to poor overall survival. Patients with early-stage disease are likely to benefit from a combination of radical surgery and platinum-based neoadjuvant chemotherapy.

Clinicopathological characteristics and survival outcomes of bladder neuroendocrine carcinomas: a population-based study

“… 17 A combination of radical surgery and platinum-based neoadjuvant chemotherapy has been shown to improve survival. 18 According to the National Cancer Database data, radical cystectomy plus chemotherapy and chemoradiation therapy are associated with better OS compared to monotherapy. 19 Another study found that chemotherapy improved patient survival in localized stage, regional stage, and distant stage disease in conjunction with transurethral resection; radiation positively affects the survival after transurethral resection of bladder tumor (TURBT) in regional stage disease.…”

An Asymptomatic Small-Cell Bladder Cancer Until Bilateral Ureteral Obstruction Happened

“…Although older age and smoking are putative risk factors for this type of carcinoma, the role of familial or genetic predisposition is uncertain [4]. The age, gender predilection and symptoms at presentation of SCBC are similar to those of bladder urothelial carcinoma [5].…”

“…A study did not reveal any difference in patients treated with or without cystectomy; however, the 5-year cancer-specific survival rate was only 16% [7]. But neoadjuvant chemotherapy followed by surgery (in case of a surgically resectable tumor is existing) can result in a 5-year survival of 80% [4]. Chemotherapy can be useful for all stages of SCBC among patients who were treated with TUR, but it is not effective in addition to cystectomy [1].…”

“…We also could not establish any metastases. SCBC management is not well-known and it is usually treated as smallcell lung cancer with the exception that surgical therapies are often an important part of management in SCBC [4]. A study did not reveal any difference in patients treated with or without cystectomy; however, the 5-year cancer-specific survival rate was only 16% [7].…”

Successful Multidisciplinary Therapy for Small Cell Carcinomas Arising from the Extrahepatic Bile Duct

“…However, according to a previous retrospective study, surgery after neoadjuvant chemotherapy can improve the prognosis of patients with clinical stage IIIA or IIIB of SCC of the lung if complete regression of mediastinal nodes has been achieved by neoadjuvant chemotherapy (13). Furthermore, in SCC of the bladder, neoadjuvant chemotherapy followed by surgery is reported to have beneficial roles for improving the patient survival (14). The pre- sent case suggests that, in SCC of the biliary duct, surgical resection after previous therapy composed of platinum-based chemotherapy with radiation can achieve a long-term survival.…”