Small cell cancer of the bladder: The Leon-Berard cancer centre experience

Abstract

Background:Small cell bladder carcinoma is an uncommon tumor. In this retrospective study we report our experience dealing with this disease at the Leon-Berard Cancer Centre.Materials and Methods:We retrospectively analyzed various characteristics of small cell bladder carcinoma: patient demographics, histological diagnosis, disease stage, treatment effects and outcome, in 14 non-metastatic small cell bladder carcinoma patients treated at our institution between 1995 and 2006.Results:The mean age at diagnosis was 60 years (range, 45-77). All patients were male. Seventy-five per cent were smokers. All had locally advanced disease. Ten patients (71.4%) were treated by cystoprostatectomy and bilateral pelvic lymph node resection, one by cystoprostatectomy alone. Two patients received neoadjuvant chemotherapy and four received adjuvant chemotherapy. One patient was treated by radiotherapy with concomitant cisplatin after transurethral resection of bladder tumor (TURBT). One patient refused surgery and was treated by chemotherapy alone. One patient was lost to follow-up after TURBT. After 49-month median follow-up, 12 patients had relapsed. Disease-free survival was 5.7 months. The most frequent sites of relapse were the retroperitoneal lymph node (seven patients) and the liver (three patients). Nine patients died of metastasis. Median overall survival was 29.5 months. Survival probability at two years was 58%. Median overall survival was 34 months in the mixed small carcinoma group, as compared with 9.5 months in the pure small cell carcinoma group (P=0.01). Mean overall survival was 27.2 months for all patients and 38.6 months for patients treated with cystectomy and adjuvant chemotherapy.Conclusion:To date, the optimal treatment for locally advanced small cell bladder carcinoma is not clear. Cystectomy with neoadjuvant or adjuvant chemotherapy appears as a viable option.

Genitourinary Small-Cell Carcinoma: A Single-Institution Experience

“…It would appear that, compared with having pure scc, having a mixed-histology malignancy confers an adverse prognosis (6.4 months vs. 11.2 months, p = 0.02). That finding conflicts with those in other studies, which found that patients have a similar or better prognosis with mixed ub scc than with pure ub scc 8, 15 .…”

Management of small cell carcinoma of the bladder: Consensus guidelines from the Canadian Association of Genitourinary Medical Oncologists (CAGMO)

“…As in urothelial carcinoma of the bladder (UCB), the mean age is 65 years, with male predominance, and an association with smoking. [20][21][22] Analogous to UCB, presenting symptoms of SCCB are often related to the presence of a bladder mass and include hematuria, 14,15,20,23,24 dysuria, nocturia, frequency, urinary obstructive symptoms and localized abdominal/ pelvic pain. 14,22,23,25 However, the natural history of SCCB is more aggressive and is associated with poorer prognosis than UCB.…”

“…14,22,23,25 However, the natural history of SCCB is more aggressive and is associated with poorer prognosis than UCB. Therefore, in most cases, SCCB will be locally advanced or metastatic [20][21][22][23][26][27][28][29] at diagnosis and follow a pattern of metastases similar to UCB. The most common sites of spread are regional and distant lymph nodes, liver and bones.…”

“…15,29,24,39 In addition, patients with a pure SCCB have a median overall survival for nonmetastatic, metastatic or recurrent disease (4.5-9.5 months) that is 2 to 3 times shorter compared to mixed SCCB. 21,26 Immunohistochemical staining is important to support a diagnosis of SCCB, which typically exhibits both epithelial and neuroendocrine differentiation. Several different tumour markers of neuroendocrine differentiation have been demonstrated in 30% to 100% of cases of SCCB, with variable results across studies.…”

Multidisciplinary approach in the treatment of patients with small cell bladder carcinoma

“…The proportion of patients with advanced disease at diagnosis ranges from 32% to 56% in most retrospective analyses 12,19,24 . Early metastatic spread is usually observed in small cell urinary carcinoma explaining the high relapse rate and the short disease free survival 3,4,19,25,26 .…”