Genitourinary small cell carcinoma: Analysis of clinical and treatment factors associated with survival among patients in the Veterans Affairs Health System.

Abstract

e15073 Background: Primary small cell carcinomas of the genitourinary tract (SCC-GUT) are rare, aggressive, and rapidly fatal neoplasms. Hence no prospective studies evaluating the most effective treatment have been done. We aim to characterize the clinicopathologic features and evaluate the treatment outcomes of SCC-GUT in adult patients. Methods: Retrospective analysis of 196 patients diagnosed with small cell carcinoma of the GU tract from 1995 to 2008 was done via the Veteran's Affairs Central Cancer Registry. Demographic, staging, treatment and outcome data was recorded. Staging was classified as limited (confined to true and false pelvis) or extensive disease (metastatic or spread outside pelvis). Results: We found 64 patients with SCC of prostate and 132 patients with SCC of bladder representing 0.06% and 0.45% of all prostate and bladder cancers.The median age of diagnosis was 69.1 years (range: 53-89).109 patients had limited disease, 67 patients had extensive disease and 20 patients were not staged adequately. Patients received variety of treatments (Table) with different survival outcomes. Limited stage bladder SCC have better survival when multimodality therapy combining chemotherapy with radiation or surgery is used whereas in limited stage prostate SCC surgical resection provided the best outcomes. Conclusions: Limited stage appears to have better survival with multimodality therapy involving chemotherapy in bladder SCC and in prostate SCC surgical resection is associated with better outcomes. Prognosis of extensive stage SCC-GUT irrespective of site is dismal. Targeted therapies are now established for several diseases, randomized trials incorporating novel targeted agents are needed to improve survival. Stage and treatment Median survival (months) Bladder Prostate Limited disease 13.4 (n=90) 16.1 (n=19) No treatment 1.9 (n=4) 9.1 (n=3) Single-modality therapy 8.2 (n=31) 46.5 (n=6) Multimodality therapy 16.4 (n=55) 11.2 (n=10) Extensive disease 4.2 (n=30) 5.7 (n=37) No treatment 1.5 (n=4) 1.1 (n=11) Single-modality therapy 3.6 (n=14) 10.3 (n=15) Multimodality therapy 8.8 (n=12) 12.2 (n=11) No significant financial relationships to disclose.