Neuroendocrine carcinoma of the bladder: do they have a worse prognosis? A large retrospective cohort study by propensity score matching analysis

Abstract

Background: The aim was to develop nomograms by integrating clinical characteristics and treatment data to predict overall survival (OS) and cancer-specific survival (CSS) for bladder patients including urothelial carcinoma (UC) and neuroendocrine bladder cancer (NEBC).

Methods: We utilized the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015) to compare the OS and CSS between NEBC and UC. Multivariable Cox analyses and propensity score matching (PSM) were employed for analysis. Then, we developed nomograms based on multivariate analysis. Kaplan-Meier curves were used to analyze the OS and CSS, and curves' differences were compared by the log-rank test.

Result: The median OS for NEBC patients who underwent transurethral resection of bladder tumor (TURBT) was 15 months, compared to 11 months for UC patients after PSM ( P = 0.001). Similarly, the median OS for patients who underwent radical cystectomy was 25 months for NEBC and 70 months for UC ( P = 0.001). The median CSS for NEBC patients who did not receive treatment was 7 months, while it was 13 months for those who underwent TURBT, 33 months for those who underwent RC, and 15 months for those who received other medical treatments. Multivariate Cox regression revealed that histological type, age at diagnosis, married, race, stage_T, stage_N, stage_M, and surgery were independent prognostic factors for OS and CSS. Multivariate analysis also indicated that chemotherapy was independent prognostic factors for OS. Then, we developed nomograms to assist clinicians in more accurately predicting 1-year, 3-year, and 5-years OS and CSS rate.

Conclusion: Compared with UC, NEBC has shorter overall survival and cancer specific survival. Besides, histological type, age at diagnosis, married, race, stage_T, stage_N, stage_M, surgery and chemotherapy were the independent prognostic factors for overall survival, while histological type, age at diagnosis, married, race, stage_T, stage_N, stage_M and surgery were independent prognostic factors for cancer specific survival. We developed and confirmed first nomograms including treatment information to forecast 1-year, 3-year, and 5-year OS and CSS for patients. These results should guide the development of consensus best practice guidelines for treating and managing NEBC patients.

Keywords: carcinoma; neuroendocrine; prognosis; propensity score matching; urinary bladder neoplasms; urothelial carcinoma.

Figure 1.

(A) Nomograms predicting OS of bladder cancer patients after PSM. (B) Nomograms predicting CSS of bladder cancer patients after PSM. (C) OS of bladder cancer patients after PSM in the NEBC group and UC group. (D) CSS of bladder cancer patients after PSM in the NEBC group and UC group. Note: NEBC: neuroendocrine carcinoma; UC: urothelial carcinoma; SDW: separated + divorced + widowed; NMIBC: non-muscle-invasive bladder cancer; MIBC: muscle-invasive bladder cancer; TURBT: transurethral resection of bladder tumor; RC: radical cystectomy; OS: overall survival; CSS: cancer-specific survival; PSM: propensity score match.

Figure 2.

OS and CSS in surgery after PSM in the NEBC group and UC group. Note: NEBC: neuroendocrine carcinoma; UC: urothelial carcinoma; TURBT: transurethral resection of bladder tumor; RC: radical cystectomy; OS: overall survival; CSS: cancer-specific survival; PSM: propensity score match.