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.

Keywords: Bladder; cancer; small cell.

Figure 1

Disease-Free Survival (DFS): The delay of disease-free survival was calculated by the date of surgery until the date of revealing of a progress or until the date of death, or until the date of last news. The median duration of survival without progress is presented as well as the median follow-up and the rate of survival without progress in two years. N = 14 (12 events); Survival median: 5.7 months; Survival probability at two years: 28%

Figure 2

Overall survival (OS): The delay of overall survival was calculated by the date of diagnosis until the death or until the date of last news. The median duration of global survival is presented as well as the median follow-up and the rate of global survival in two years. N = 14 (nine events); Survival median: 29.5 months; Survival probability at two years: 58%

Figure 3

Disease-free survival in patients with pure neuroendocrine tumors of bladder vs. tumors with mixed histology: The median duration of disease-free survival (indicated by the dotted lines) was 8.6 months in the mixed small cell carcinoma (SmCC) group, as compared with 3.7 months in the pure group (P=0.3)

Figure 4

Overall survival in patients with pure neuroendocrine tumors of bladder vs. tumors with mixed histology: The median duration of survival (indicated by the dotted lines) was 34 months in the mixed small cell carcinoma (SmCC) group, as compared with 9.5 months in the pure SmCC group (P = 0.01)