Clinicopathological Features and Outcomes of Perioperative Treatment for Small Cell Carcinoma of the Bladder

DENG Jiani, ZHANG Mengni, YANG Miao, ZHANG Peng, SHEN Yali

Abstract

Small cell carcinoma of the bladder (SCCB) is a rare malignant tumor of the bladder. This study aims to explore its clinicopathological features and prognostic factors and to explore the role of perioperative treatment methods.

Methods 

The clinical data of SCCB patients admitted to West China Hospital, Sichuan University over 8 years from January 2016 to January 2024 were collected. The clinicopathological features of SCCB were summarized. The survival outcomes and prognostic factors were analyzed. The effect of perioperative treatment on the improvement in prognosis was explored.

Results 

A total of 31 confirmed cases of SCCB were enrolled. We observed a number of clinicopathologic features. All cases had advanced clinical staging, with the T staging status being above T2 in all cases, and distant metastasis was found in 23% of the newly diagnosed cases. A high proportion of the SCCB cases were combined with other histologic types, with 96% showing combination with urothelial carcinoma (UC). The SCCB patients had a poor prognosis, presenting a median survival of 12 months, 1-year overall survival (OS) of 57.9%, and 3-year OS of 27.6%. Patients with extensive-stage SCCB had a significantly worse prognosis than those with limited-stage SCCB did (median OS time of 17.0 months vs. 4.4 months, P<0.05). In limited-stage SCCB, the median OS of patients who underwent radical cystectomy (RC) was 19.9 months, while that of the patients who did not undergo RC was 15.2 months (P<0.05). The OS of patients who received perioperative therapy in combination with RC had longer OS than those who received only RC did (P<0.05). Among these, patients recevied neoadjuvant therapy (NAT) had a significantly longer OS than patients who didn't receive NAT (P<0.05). Subgroup analysis revealed that patients who were responsive to neoadjuvant therapy had longer disease-free survival and longer OS than those who were not responsive did (P<0.05). Lymph node metastasis was an independent factor of poor prognosis (hazard ratio [HR]=15.21, 95% confidence interval [CI]: 1.732-133.912, P=0.014). NAT prior to RS was an independent protective factor, significantly reducing the risk of death compared with RC alone (HR=0.03, 95% CI: 0.001-0.724, P=0.031).

Conclusion 

RC is an effective treatment that prolongs the survival of patients with limited-stage SCCB. RS combined with NAT can further improve their survival.

 

Keywords: Small cell carcinoma of the bladder, Clinicopathologic features, Prognostic factors, Neoadjuvant therapy, Perioperative treatment

 

Full Text:

PDF


References


CRAMER S F, AIKAWA M, CEBELIN M. Neurosecretory granules in small cell invasive carcinoma of the urinary bladder. Cancer, 1981, 47(4): 724–730. doi: 10.1002/1097-0142(19810215)47:4<724::aid-cncr282 0470417>3.0.co;2-2.

KOUBA E J，CHENG L . Understanding the genetic landscape of small cell carcinoma of the urinary bladder and implications for diagnosis, prognosis, and treatment: a review. JAMA Oncol, 2017, 3(11): 1570–1578. doi: 10.1001/jamaoncol.2016.7013.

KOAY E J, TEH B S, PAULINO A C, et al. A surveillance, epidemiology, and end results analysis of small cell carcinoma of the bladder: epidemiology, prognostic variables, and treatment trends. Cancer, 2011, 117(23): 5325–5333. doi: 10.1002/cncr.26197.

CHOONG N W, QUEVEDO J F, KAUR J S. Small cell carcinoma of the urinary bladder. The Mayo Clinic experience. Cancer, 2005, 103(6): 1172–1178. doi: 10.1002/cncr.20903.

CHENG L, JONES T D, MCCARTHY R P, et al. Molecular genetic evidence for a common clonal origin of urinary bladder small cell carcinoma and coexisting urothelial carcinoma. Am J Pathol, 2005, 166(5): 1533–1539. doi: 10.1016/s0002-9440(10)62369-3.

CHANG M T, PENSON A, DESAI N B, et al. Small-cell carcinomas of the bladder and lung are characterized by a convergent but distinct pathogenesis. Clin Cancer Res, 2018, 24(8): 1965–1973. doi: 10.1158/ 1078-0432.Ccr-17-2655.

FUJII T, SHIMADA K, TATSUMI Y, et al. microRNA-145 promotes differentiation in human urothelial carcinoma through down-regulation of syndecan-1. BMC Cancer, 2015, 15: 818. doi: 10.1186/s12885-015-1846-0.

GAISA N T, TILKI D, LOSEN I, et al. Insights from a whole cystectomy specimen--association of primary small cell carcinoma of the bladder with transitional cell carcinoma in situ. Hum Pathol, 2008, 39(8): 1258–1262. doi: 10.1016/j.humpath.2007.12.017.

WANG G, XIAO L, ZHANG M, et al. Small cell carcinoma of the urinary bladder: a clinicopathological and immunohistochemical analysis of 81 cases. Hum Pathol, 2018, 79: 57–65. doi: 10.1016/j.humpath.2018.05.005.

TRIAS I, ALGABA F, CONDOM E, et al . Small cell carcinoma of the urinary bladder. Presentation of 23 cases and review of 134 published cases. Eur Urol, 2001, 39(1): 85–90. doi: 10.1159/000052417.

molecular characterization of muscle-invasive bladder cancer. Cell, 2018, 174(4): 1033. doi: 10.1016/j.cell.2018.07.036.

OSER M G, FONSECA R, CHAKRABORTY A A, et al. Cells lacking the RB1 tumor suppressor gene are hyperdependent on Aurora B kinase for survival. Cancer Discov, 2019, 9(2): 230–247. doi: 10.1158/2159-8290.Cd-18-0389.

XI J, MA C X. Sequencing endocrine therapy for metastatic breast cancer: what do we do after disease progression on a CDK4/6 inhibitor? Curr Oncol Rep, 2020, 22(6): 57. doi: 10.1007/s11912-020-00917-8.

Van De KAMP M, MEIJER R, POS F, et al. Intravesical recurrence after bladder sparing treatment of small cell carcinoma of the bladder: Characteristics, treatment, and outcome. Urol Oncol, 2018, 36(6): 307.e1–307.e8. doi: 10.1016/j.urolonc.2018.02.015.

NIU Q, LU Y, XU S, et al. Clinicopathological characteristics and survival outcomes of bladder neuroendocrine carcinomas: a population-based study. Cancer Manag Res, 2018, 10: 4479–4489. doi: 10.2147/cmar. S175286.

MOLLICA V, MASSARI F, ANDRINI E, et al. Prognostic factors of survival for high-grade neuroendocrine neoplasia of the bladder: a SEER database analysis. Curr Oncol, 2022, 29(8): 5846–5854. doi: 10.3390/curroncol29080461.

National Comprehensive Cancer Network. NCCN Guidelines. [2024-08-29]. https://wwsw.nccn.org/guidelines/guidelines-detail?category=1&= 1417.

LYNCH S P, SHEN Y, KAMAT A, et al. Neoadjuvant chemotherapy in small cell urothelial cancer improves pathologic downstaging and long-term outcomes: results from a retrospective study at the MD Anderson Cancer Center. Eur Urol, 2013, 64(2): 307–313. doi: 10.1016/j.eururo. 2012.04.020.

TEO M Y, GUERCIO B J, ARORA A, et al. Long-term outcomes of local and metastatic small cell carcinoma of the urinary bladder and genomic analysis of patients treated with neoadjuvant chemotherapy. Clin Genitourin Cancer, 2022, 20(5): 431–441. doi: 10.1016/j.clgc.2022.05.005.

AKEZHOULI SHAHATIAILI, QIAN L, ZHANG T X, et al. Clinical and pathological characteristics of small cell carcinoma of bladder and the efficacy of neoadjuvant therapy. J Mod Urol, 2023, 28(6): 474–479. doi: 10.3969/j.issn.1009-8291.2023.06.004.

SHEN P, JING Y, ZHANG R, et al. Comprehensive genomic profiling of neuroendocrine bladder cancer pinpoints molecular origin and potential therapeutics. Oncogene, 2018, 37(22): 3039–3044. doi: 10.1038/s41388-018-0192-5.


Refbacks

  • There are currently no refbacks.