Genitourinary small-cell carcinoma: 11-year treatment experience

Abstract

The predictive factors of prognosis and treatment strategies for small-cell carcinoma (SCC) of the urinary tract are controversial. This study was aimed to investigate the clinical experience and management of patients with SCC of the urinary tract. We collected data of patients who were diagnosed with genitourinary SCC (GSCC) between 2002 and 2013 and were treated in the Fudan University Shanghai Cancer Center. A total of 18 patients were diagnosed with GSCC of which 10 originated from the prostate, seven from the bladder and one from the adrenal gland. The mean follow-up time was 15.5 months and progression-free survival (PFS) was 9.3 months. Primary tumor resection was attempted in 13 of 18 patients (72.2%) in whom radical surgery was performed in six of 14 (42.9%) limited disease patients. Most of the patients (13, 72.2%) received cisplatin-based chemotherapy. Patients who had normal lactic dehydrogenase (LDH) levels showed a significantly higher median PFS and overall survival (OS) compared with patients with high LDH levels (P = 0.030, P= 0.010). Patients with limited disease treated with a radical operation experienced a non-significant (P = 0.211) longer PFS compared with patients who were not treated, but this reached statistical significance after analyzing OS (P = 0.211, P= 0.039). Our patients showed a poor prognosis as reported previously. Serum LDH levels beyond the normal range indicate a poor prognosis. For GSCC patients who are diagnosed with limited disease, radical surgery is strongly recommended along with cisplatin-based chemotherapy.

Figure 1

(a) Bladder small-cell carcinoma (SCC): H and E staining (original magnification, ×40); (b) Bladder SCC: chromogranin A immunohistochemical expression (original magnification, ×100); (c) Bladder SCC: Ki67 immunohistochemical expression (original magnification, ×100); (d) Prostate SCC: H and E staining (original magnification, ×100); (e) Prostate SCC: negative prostate-specific antigen immunohistochemical expression (original magnification, ×100); (f) Prostate SCC: synaptophysin immunohistochemical expression (original magnification, ×100).

Figure 2

Kaplan–Meier progression free survival (PFS) and overall survival (OS) curves and the log-rank test by lactic dehydrogenase levels (a and b). Kaplan–Meier PFS and OS curves and the log-rank test by radical operation (c and d)