Small Cell Carcinoma Of The Bladder Research Articles

POU2F3-positive small cell carcinoma of the bladder: A clinicopathologic analysis of 4 cases and literature review

POU class 2 homeobox 3 (POU2F3)-positive small cell bladder carcinoma (SCBC) is an extremely rare entity, and its clinicopathologic features have not been fully described. Here, we investigated the clinicopathologic features of 4 cases of POU2F3-positive small cell bladder carcinoma (SCBC) and reviewed the literature. We collected 12 cases of SCBC from our departmental archives and detected the expression of POU2F3 by immunohistochemical (IHC) staining. Selected cases with or without POU2F3 expression were subjected to gene expression analysis between two different groups using DESeq2 software. We identified 4 POU2F3-positive SCBC patients, 2 males and 2 females, with a mean age of 77 years. Three patients had hematuria, and 1 patient had dysuria. Radiologic findings showed a bladder mass. Pathologic diagnosis showed that 3 cases were pure SCBC and 1 was mixed urothelial cancer (UC). Histopathologically, four POU2F3-positive SCBC tumors were composed of small round cells with sparse cytoplasm, the nuclei were salt-and-pepper-like or finely granular. Tumor cells showed characteristic cytoplasmic staining with punctate positive signals for cytokeratin. Syn and CD56 were diffusely positive in all the 4 patients. CgA was positive in only one patient. POU2F3-positive SCBC showed higher expression levels of POU2F3, HMGA2 and PLCG2 genes by RNA-Seq. Our data showed the specific clinicopathologic features of 4 rare POU2F3-positive SCBC cases, and the distinct molecular feature was observed between POU2F3-positive and negative SCBC in the limited number of cases.

Development and validation of a novel prognostic model for disease-specific survival in patients with non-metastatic small cell carcinoma of the bladder.

695 Background: Small cell carcinoma of the bladder (SCCB) is a rare variant of bladder cancer with limited data informing prognosis. We present a novel prognostic model for disease specific survival (DSS) for patients with non-metastatic (M0) SCCB, derived from the Surveillance, Epidemiology and End Results (SEER) database. Methods: The SEER database (18 registries/November 2020) was queried with the ICD-10 topography codes C67.0-C67.9 (bladder), and the morphologic code 8041 (SCCB). Eligible patients (adults, histologic confirmation, available follow-up/staging data, M0) were randomly divided into a training (TC) and a validation cohort (VC) (7:3 ratio). Variables significantly associated with DSS were identified with multivariate Cox regression and backwards stepwise conditional approach and inserted in the model. Points were assigned to each variable based on the formula: Probability of an event at time t=S0(t)exp(β1x1, β2x2...), (β = regression coefficients, x = observed covariate values, S0(t) = survival function). Cumulative risk points were assigned to each patient and three distinct risk categories for DSS were constructed. Harrel’s C-statistic with bootstrap resampling was used for internal (TC) and external (VC) validation. Model performance was compared to the AJCC 8th edition (likelihood ratio test -LRT). Results: A total of 1039 patients were included (739 TC, 300 VC). No statistically significant differences in baseline characteristics/survival outcomes were identified between TC and VC. Age (years), T/N stage, radical cystectomy, chemotherapy, and radiation were significant variables inserted in the multivariate model (table). Patients were stratified to three risk groups (low, intermediate, high) based on the total cumulative risk points collected. Median DSS was NR (95%CI; NR, NR), 25 (95% CI; 18-32) and 9 months (95% CI; 7-11) for the low, intermediate, and high-risk category, log-rank p<.001. Harrel's C-statistic for the model was 0.70 (95%CI;0.67-0.73) in the TC and 0.66 (95%CI; 0.61-0.71) in the VC. In comparison, C-statistic for the AJCC 8th edition was 0.56 (95% CI; 0.52-0.59) and 0.53 (95% CI; 0.51 to 0.57), respectively. The LRT demonstrated superior performance of the model compared to AJCC (p<.001). Conclusions: We present a novel prognostic model for DSS in patients with locoregional SCCB composed of variables readily available in daily practice, which may serve as a useful tool for individualized risk assessment of patients with this rare malignancy. Further validation in prospective studies/clinical trials is warranted. [Table: see text]

Multidisciplinary treatment for small cell carcinoma of the bladder: a case report.

Small cell carcinoma (SCC) of the urinary bladder is a rare and highly aggressive subtype of bladder cancer. Most cases are diagnosed at advanced stages, and its therapeutic strategy remains unestablished. Here, we report a case of bladder SCC in which multidisciplinary treatment has resulted in relatively long-term survival. A 68-year-old man presented with gross hematuria. A cystoscopy revealed an invasive bladder tumor. A transurethral resection of bladder tumor (TURBT) was performed, and the pathological diagnosis was SCC. After systemic chemotherapy using etoposide and carboplatin and subsequent TURBT, a radical cystectomy and ileal conduit were performed. Three months postoperatively, the patient had a recurrence in the para-aortic lymph node. Systemic combination chemotherapy with carboplatin plus irinotecan (CBDCA + CPT-11) was administered, followed by amrubicin and an immune checkpoint inhibitor. In addition to this treatment, radiation therapy for the metastatic region led to the reduction of pain and shrinkage of the metastatic lesion. The patient survived for 2years after the initial diagnosis. Our report indicates that multidisciplinary treatment can be effective for SCC of the bladder, and a therapeutic strategy including the identification of novel biomarkers should be established.

Primary Small Cell Neuroendocrine Carcinoma of Bladder – A Rare Diagnostic Entity

Primary small cell carcinoma of the bladder is very rare pathological entity, follows an aggressive course and carries poor prognosis. The literature carrying these articles are scarce and due to which it poses a diagnostic challenge to the radiologist and urologists. Herein, we present a case of small cell carcinoma of urinary bladder in a 75 year old male patient initially reported as poorly differentiated urothelial carcinoma on transurethral resection of bladder tumor specimen to emphasize its rarity as well as the role of immunohistochemistry to differentiate between the two.

Association between radiotherapy and prognosis in patients with small cell carcinoma of the bladder undergoing bladder-sparing surgery.

Small cell carcinoma of the bladder is rare and has a poor prognosis. This study aimed to investigate whether radiotherapy after bladder-sparing surgery could improve the survival benefits of patients. This population-based retrospective cohort study used data from the Surveillance, Epidemiology, and End Results cohort in the United States to investigate small cell carcinoma of the bladder. Univariate and multivariate Cox regression analyses were used to identify significant risk factors influencing the clinical prognosis. A propensity score matching (PSM) algorithm was used to reduce the interference of confounding factors in each study group. The matched groups underwent Kaplan-Meier survival analysis to assess the potential survival benefits. Univariate regression analysis demonstrated that age (P<0.001), tumour stage (T stage) (P=0.005), node stage (N stage) (P<0.001), chemotherapy (P<0.001), bone metastasis (P<0.001), liver metastasis (P<0.001), lung metastasis (P=0.005), tumour size (P=0.005), and radiotherapy (P<0.001) were related factors affecting survival. Multivariate regression analysis revealed that age (P=0.001), T stage (P=0.054), N stage (P<0.001), radiotherapy (P=0.010), chemotherapy (P<0.001), bone metastasis (P=0.007), and liver metastasis (P<0.001) were independent factors affecting survival. Moreover, survival analysis was performed on the PSM-matched groups, leading to the following findings: (1) the radiotherapy group exhibited a superior survival prognosis compared with the non-radiotherapy group (P<0.001); (2) the survival prognosis of individuals who underwent radiotherapy and chemotherapy was higher than that of those who underwent chemotherapy alone (P<0.001). The findings of this study suggest that radiotherapy improves survival benefits for patients with small cell carcinoma of the bladder who undergo bladder-sparing surgery. Furthermore, radiotherapy combined with chemotherapy demonstrates a greater survival benefit compared with chemotherapy alone. The results underscore the importance of considering radiotherapy as a valuable treatment option for such patients, highlighting its potential benefits in improving their overall prognosis.

Surveillance of prognostic risk factors in patients with SCCB using artificial intelligence: a retrospective study

Small cell carcinoma of the bladder (SCCB) is a rare urological tumor. The prognosis of SCCB is abysmal. Therefore, this study aimed to construct nomograms that predict overall survival (OS) and cancer-specific survival (CSS) in SCCB patients. Information on patients diagnosed with SCCB during 2004–2018 was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression models analyzed Independent risk factors affecting patients' OS and CSS. Nomograms predicting the OS and CSS were constructed based on the multivariate Cox regression model results. The calibration curve verified the accuracy and reliability of the nomograms, the concordance index (C-index), and the area under the curve (AUC). Decision curve analysis (DCA) assessed the potential clinical value. 975 patients were included in the training set (N = 687) and the validation set (N = 288). Multivariate COX regression models showed that age, marital status, AJCC stage, T stage, M stage, surgical approach, chemotherapy, tumor size, and lung metastasis were independent risk factors affecting the patients' OS. However, distant lymph node metastasis instead AJCC stage is the independent risk factor affecting the CSS in the patients. We successfully constructed nomograms that predict the OS and CSS for SCCB patients. The C index of the training set and the validation set of the OS were 0.747 (95% CI 0.725–0.769) and 0.765 (95% CI 0.736–0.794), respectively. The C index of the CSS were 0.749 (95% CI 0.710–0.773) and 0.786 (95% CI 0.755–0.817), respectively, indicating that the predictive models of the nomograms have excellent discriminative power. The calibration curve and the AUC also show good accuracy and discrimination of the nomograms. To sum up, We established nomograms to predict the OS and CSS of SCCB patients. The nomograms have undergone internal cross-validation and show good accuracy and reliability. The DCA shows that the nomograms have an excellent clinical value that can help doctors make clinical-assisted decision-making.

V08-08 ENDOSCOPIC URETHRAL STUMP CLOSURE WITH A NOVEL SUTURE DEVICE

You have accessJournal of UrologyCME1 Apr 2023V08-08 ENDOSCOPIC URETHRAL STUMP CLOSURE WITH A NOVEL SUTURE DEVICE Bridget l. Findlay, jayson P. Kemble, Felicia L. Balzano, and Jonathan N. Warner Bridget l. FindlayBridget l. Findlay More articles by this author , jayson P. Kemblejayson P. Kemble More articles by this author , Felicia L. BalzanoFelicia L. Balzano More articles by this author , and Jonathan N. WarnerJonathan N. Warner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Symptomatic lymphoceles are a rare occurrence following pelvic lymph node dissection. Persistent lymphoceles can affect scarring and closure of the urethral stump following radical cystectomy. While this is a rare occurrence, traditional management includes endoscopic fulguration of the proximal urethral stump. Herein, we aim to describe a novel endoscopic technique for urethral stump closure in a patient with persistent urethral drainage in the setting of a recurrent pelvic lymphocele following radical cystectomy. METHODS: A 60-year-old male with history of muscle invasive small cell carcinoma of the bladder underwent robotic assisted radical cystectomy with pelvic and para-aortic lymph node dissection and Indiana pouch creation in November 2021 following neoadjuvant chemotherapy. He developed a symptomatic lymphocele in February 2022 with persistent urethral drainage. He underwent aspiration of the pelvic fluid collection and endoscopic urethral fulguration without improvement. He was then referred for second opinion, where he elected to proceed with endoscopic fulguration and closure using a laparoscopic suture device (RD-180; LSI Solutions, Rochester, NY) and novel endoscopic sheath (JNW UrtractTM; LSI Solutions, Rochester, NY). Prior to surgery, a pigtail drain was placed in the pelvic fluid collection. The proximal stump was fulgurated using the bipolar plasma band via a 27 Fr cystourethroscope (Olympus Surgical Technologies America, Westborough, MA) to facilitate scarring. The stump was closed using the RD-180 under direct visualization in a figure of eight fashion both proximally at the opening and 1cm distally. Knots were fashioned using the Ti-Knot fastener (LSI Solutions, Rochester, NY). RESULTS: Total operative time was 37 minutes and the patient discharged same day. His follow-up CT scan locally 2 months postoperatively demonstrated resolution of the pelvic fluid collection, and his drain was removed. He remains asymptomatic without recurrence of urethral drainage 4 months postoperatively. CONCLUSIONS: To our knowledge, this is the first described case of endoscopic closure of a urethral stump in the setting of persistent drainage from a pelvic lymphocele. Fulguration with endoscopic closure using a novel device is both a safe and efficacious alternative to performing urethral fulguration alone. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e751 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bridget l. Findlay More articles by this author jayson P. Kemble More articles by this author Felicia L. Balzano More articles by this author Jonathan N. Warner More articles by this author Expand All Advertisement PDF downloadLoading ...

Poorly Differentiated Neuroendocrine Tumor of the Bladder: A Case Report

Neuroendocrine tumors rarely occur in the urinary bladder, relatively less than 1% of occurrence, as the tumor is very rare, pathogenesis is uncertain some authors showed that it is from urothelial origin. It can be carcinomatous, subdivided into small cell and large cell pathology. Small cell carcinoma of the bladder is a rarity that may present at an advanced pathologic stage. No treatment regimens have been standardized for local or metastatic disease. Many publications showed that the disease is treated with combined chemotherapy or with radical cystectomy, here we are presenting a case of a 78 years old male, who underwent transurethral resection of bladder 1 month ago and the biopsy report was suggestive of neuroendocrine tumor of bladder, after that patient underwent radical cystectomy with neobladder reconstruction surgery.

Survival analysis of small cell carcinomas of the genitourinary system

Due to low incidence, there are no large prospective studies or clinical trials for small cell carcinoma (SCC) of the genitourinary system (GU), and most data are extrapolated from SCC of the lung. Using the SEER database, we analyzed incidence trends, overall survival, and cancer-specific survival using the log-rank test. Analysis of variables was performed using the Cox proportional hazards regression model. The analysis showed that SCC of the bladder and prostate were the most common types of GU SCC, with 1836 and 606 cases, respectively. In 2018, the incidence of SCC of the bladder and prostate was twice that of 2010 (P < 0.001). The overall survival and cancer-specific survival of patients with SCC of the bladder were significantly longer than those of patients with SCC of the prostate (P < 0.0001). SCC bladder patients with advanced age, more extensive growth, lymph node involvement, no surgical intervention, and the presence of the metastasis had worse survival outcomes (P < 0.05). The Asian/Pacific Islander race provided some survival benefits for patients with SCC of the bladder (P < 0.05). For patients with SCC of the prostate, only advanced age was a risk factor for poor outcomes (P < 0.05).

Surgical resection of mediastinal metastasis from small cell carcinoma of bladder: case report

BackgroundIsolated mediastinal metastasis from a malignant tumor and small cell carcinoma of the bladder are both very rare.Case presentationA 76-year-old woman who had undergone surgery for bladder cancer twice was referred to our hospital for a right paracardiac mass noted in chest computed tomography findings, and resection of the tumor was performed. Histological analysis of the mediastinal tumor revealed it to be a metastatic small cell carcinoma of the bladder. At 4 months after surgery, multiple metastatic lesions were found in the chest and liver, and chemotherapy for small cell carcinoma was started.ConclusionsWe present this case of mediastinal metastasis of small cell carcinoma of the bladder, which is very rare, to show the importance of surgical resection of an isolated mediastinal tumor. Such a procedure should be considered, as histological diagnosis of the tumor could be useful for determining therapeutic options.

Long-term Outcomes of Local and Metastatic Small Cell Carcinoma of the Urinary Bladder and Genomic Analysis of Patients Treated With Neoadjuvant Chemotherapy.

Small cell carcinoma of the bladder (SCCB) is a rare variant of bladder cancer with poor outcomes. We evaluated long-term outcomes of nonmetastatic (M0) and metastatic (M1) SCCB and correlated pathologic response with genomic alterations of patients treated with neoadjuvant chemotherapy (NAC). Clinical history and pathology samples from SCCB patients diagnosed at our institution were reviewed. One hundred and ninety-nine SCCB patients were identified. (M0: 147 [74%]; M1: 52 [26%]). Among M0 patients, 108 underwent radical cystectomy (RC) (NAC: 71; RC only: 23; adjuvant chemotherapy: 14); 14 received chemoradiotherapy; the rest received chemotherapy alone or no cancer-directed therapy. RC-only patients had a median follow-up of 9.1 years, and median disease-free survival (DFS) and overall survival (OS) were 1.1 and 1.2 years, respectively. NAC patients had pathologic response (<pT2pN0) and pathologic complete response (pT0pN0) rates of 48% and 38%, respectively, with median follow-up of 7.2 years, and median DFS and OS of 5.6 and 14.5 years, respectively. NAC responders (<ypT2N0) had superior median DFS (14.5 vs. 0.6 years, hazard ratio [HR] 0.24, P< .001) and OS (14.5 vs. 2.5 years, HR 0.31, P = .002). DFS rates for responders and nonresponders were 76% and 27% at 5 years, and 71% and 23% at 10 years, respectively. Local and central nervous system recurrences were infrequent. Median progression-free survival (PFS) and OS for M1 disease were 6.9 and 10.3 months, respectively. Genomic profiling was performed on 47 NAC patients. Loss of ERCC2 function was significantly enriched among those with pathologic complete response to NAC (mutations present in 50% of pathologic complete responders vs. 15% nonresponders, P = .045). M0 SCCB is chemo-sensitive and patients have excellent long-term survival following response to NAC. Patients with M1 disease have poor survival despite systemic therapy. Loss-of-function mutations of ERCC2 were associated with pathologic complete response to NAC.

Small cell carcinoma of the urinary bladder: Distinctive cytological characteristics and Cyto-histologic correlation

Preoperative diagnosis in liquid-based cytology preparation in voided urine specimen and cyto-histologic correlation of small cell carcinoma of the urinary bladder has not been described in detail in the literature. A 79-year old male presented at our institution with gross hematuria. He was accurately diagnosed with small cell carcinoma of the bladder on liquid-based cytology in urine. The patient subsequently proceeded to transurethral resection of the bladder tumor, confirming the diagnosis. In this article, we present a detailed report of primary urothelial carcinoma with dominant neuroendocrine differentiation of the bladder describing the cytologic and histologic morphologic features, its differential diagnosis with a review of the literature.

Primary Small Cell Neuroendocrine Carcinoma of Bladder – A Rare Diagnostic Entity

Primary small cell carcinoma of the bladder is very rare pathological entity, follows an aggressive course and carries poor prognosis. The literature carrying these articles are scarce and due to which it poses a diagnostic challenge to the radiologist and urologists. Herein, we present a case of small cell carcinoma of urinary bladder in a 75-year-old male patient initially reported as poorly differentiated urothelial carcinoma on transurethral resection of bladder tumor specimen to emphasize its rarity as well as the role of immunohistochemistry to differentiate between the two.

Primary Small Cell Neuroendocrine Carcinoma of Bladder – A Rare Diagnostic Entity

Primary small cell carcinoma of the bladder is very rare pathological entity, follows an aggressive course and carries poor prognosis. The literature carrying these articles are scarce and due to which it poses a diagnostic challenge to the radiologist and urologists. Herein, we present a case of small cell carcinoma of urinary bladder in a 75-year-old male patient initially reported as poorly differentiated urothelial carcinoma on transurethral resection of bladder tumor specimen to emphasize its rarity as well as the role of immunohistochemistry to differentiate between the two.

Small cell carcinoma of the bladder: A population-based analysis of long-term outcomes after radical cystectomy and bladder conservation with chemoradiotherapy.

We aimed to describe the oncological outcomes after radical cystectomy and chemo-radiation for localized small cell bladder cancer (SCBC). This population-based analysis of localized SCBC from 1985-2018 in British Columbia included an analysis (analysis 1) of cancer-specific survival (CSS) and overall survival (OS) of patients treated with curative-intent radical cystectomy (RC) and radiation (RT), and an analysis (analysis 2) of CSS and OS in patients treated with RC and chemoRT consistent with the SCBC Canadian consensus guideline. Seventy-seven patients who were treated with curative intent were identified: 33 patients had RC and 44 had RT. For analysis 1, five-year OS was 29% and 39% for RC and RT, respectively (p=0.51), and five-year CSS was 35% and 52% for RC and RT, respectively (p=0.29). On multivariable analysis, higher Charlson comorbidity index (CCI) and the lack of neoadjuvant chemotherapy (NAC) were associated with worse OS, while higher CCI and Eastern Cooperative Oncology Group (ECOG) were associated with worse CSS. For analysis 2, five-year OS was 56% and 58% for the RC and chemoRT groups, respectively (p=0.90), and five-year CSS was 56% for RC and 71% for chemoRT (p=0.71). Four of 42 (9.5%) chemoRT patients had RC at relapse. SCBC is a rare entity with a poor prognosis. RC and chemoRT offer similar CSS and OS for localized SCBC, even when focusing the analysis on patients treated according to the modern consensus guidelines. NAC should be considered for eligible patients. Both chemoRT and RC treatment options should be discussed with patients with SCBC.

Clinical value of 18FDG PET/MRI in muscle-invasive, locally advanced, and metastatic bladder cancer

ObjectiveMetastatic bladder cancer is an aggressive disease that can often be difficult to diagnose and stage with conventional cross-sectional imaging. The primary objective of this study was to determine the clinical value of fluorine-18 2-fluoro-2-deoxy-D-glucose (18F-FDG) PET/MRI for surveillance and restaging of patients with muscle-invasive, locally advanced, and metastatic bladder cancer compared to conventional imaging methods. Materials and MethodsThis retrospective study enrolled patients with muscle-invasive, locally advanced and metastatic bladder cancer in a single institute evaluated with 18F-FDG PET/MRI. All patients also underwent conventional imaging with CT. Additional imaging may also have included 18F-FDG PET/CT (18F-FDG PET), or sodium fluoride (NaF) PET/CT in some patients. Images were reviewed by a diagnostic radiologist/nuclear medicine physician. Number of lesions and sites of disease were captured and compared between 18F-FDG PET/MRI and conventional imaging. Lesions were confirmed by sequential imaging or lesion biopsy. All patients were followed for survival. ResultsFifteen patients (4 for surveillance; 11 for restaging) underwent 34 18F-FDG PET/MRI scans. Each patient received a corresponding conventional CT around the time of the 18F-FDG PET/MRI (median 6 days). The 15 patients (11 male; 4 female) had a median age of 61.5 years (range 37–73) and histologies of urothelial carcinoma (n = 13) and small-cell carcinoma of the bladder (n = 2) diagnosed as stage 4 (n = 13), stage 3 (n = 1), or stage 2 (n = 1). 18F-FDG PET/MRI detected 82 metastatic malignant lesions involving lymph nodes (n = 22), liver (n = 10), lung (n = 34), soft tissue (n = 12), adrenal glands (n = 1), prostate (n = 1), and bone (n = 2) with a resultant advantage of 36% for lesion visibility in comparison with CT. Serial imaging or biopsy confirmed these lesions as malignant. Conclusion18F-FDG PET/MRI can detect metastatic lesions which cannot be identified on conventional CT, and this can allow for better treatment planning and improved disease monitoring during therapy.

Treatment Outcomes for Small Cell Carcinoma of the Bladder: Results From a UK Patient Retrospective Cohort Study.

Small cell carcinoma of the bladder (SCCB) is rare, accounting for less than 1% of all bladder carcinomas. It is aggressive, and outcomes are poor as a result of its early metastatic spread. Owing to its rarity, there are limitations on data to propose standardized management pathways. We conducted a retrospective analysis of patients presenting with pure or predominant-histology SCCB to 26 institutions in the United Kingdom between 2006 and 2016. The data cutoff date was February 1, 2018. We report patient characteristics, treatment received, and subsequent clinical outcomes. A total of 409 eligible patients were included. Among these, 306 (74.8%) were male, the median age was 71 years (range, 35-96 years), and 189 patients (46.2%) had pure-histology SCCB. At data cutoff, 301 patients (73.6%) had died. The median overall survival (OS) was 15.9 months (95% CI, 13.2-18.7 months). Two hundred patients (48.9%) were confirmed to have bladder-confined disease (N0, M0), with a median OS of 28.3 months (95% CI, 20.9-35.8 months), versus a median OS of 12.7 months (95% CI, 10.9-14.6 months) for the 172 patients (42.1%) with confirmed N1-3 and/or M1 disease (hazard ratio [HR], 2.03; 95% CI, 1.58-2.60; P < .001). A total of 247 patients (61.5%) received primary chemotherapy, with a median OS of 21.6 months (95% CI, 15.5-27.6 months), versus a median OS of 9.1 months (95% CI, 5.4-12.8 months) in patients who did not receive primary chemotherapy (HR, 0.46; 95% CI, 0.37-0.59; P < .001). Choice of chemotherapy agent did not alter outcomes. For those with bladder-confined disease, 61 (30.5%) underwent cystectomy, and 104 (52.0%) received radiation therapy. Survival outcomes were similar for both cystectomy and radiation therapy. Only 6 patients (1.5%) were identified as having brain metastases at any time point. To our knowledge, this is the largest retrospective study of all-stage SCCB to date. Patients have a poor prognosis overall, but survival is improved in those able to receive chemotherapy and with organ-confined disease. Brain metastases are rare.

PO-1205: Small cell carcinoma of the bladder: Retrospective long-term outcomes of chemoradiation

PO-1205: Small cell carcinoma of the bladder: Retrospective long-term outcomes of chemoradiation

Outcomes and Evolving Treatment Paradigms for Small Cell Carcinoma of the Bladder

Small cell carcinoma of the bladder (SmCCB) is a rare histology with a poor prognosis and an unclear treatment paradigm. To better define treatment paradigms and patient/tumor characteristics correlating with outcomes in patients with SmCCB and mixed urothelial/neuroendocrine carcinoma (NE). We retrospectively evaluated our single institution experience in patients with SmCCB/NE. Time to event analysis was performed with Kaplan-Meier estimates. Univariable (UVA), multivariable (MVA) analyses were performed to assess the impact of patient and tumor characteristics on outcomes. Between 2001-2018, 51 patients with SmCCB/NE were treated. Median age at diagnosis was 71 (range 47-85). 84% (n=43) were smokers with a median pack-year history of 30 (range 1.5-200). The proportions of clinical Stage I/II/III /IV patients at diagnosis were 4% (n=2)/57% (n=29)/24% (n=12) /16% (n=8); 16 patients were node positive (31%). A majority (82%) received neoadjuvant chemotherapy (NACT, median 4 cycles, range 1-12) and surgery (n=28, 55%; 26 radical cystectomy, 2 partial cystectomy, all with a pelvic lymph node dissection), whereas 29% (n=15) underwent definitive radiation (XRT) (13 chemoradiation, 2 XRT alone) and 18% (n=9) underwent adjuvant chemotherapy (ACT). 81% (n=34) of NACT regimens consisted of a platinum/etoposide (P/E) doublet. Of the surgical patients, 18% (n=5) had positive margins, 21% (n=6) had perineural invasion (PNI), 43% (n=12) had lymphovascular invasion (LVSI), and 25% had extracapsular extension (ECE). Proportions of pathologic Stage 0/I/II/III/IV patients were 43% (n=12)/4% (n=1)/7% (n=2)/36% (n=10)/11% (n=3). Of the NACT+surgery patients (n=24), 50% had no invasive disease (ypT0/T0is). Immunotherapy was first given to relapsed patients in 2016. Of the 14 failures since then, 50% have received immunotherapy, of whom all are still alive. With a median follow-up of 19 months (range 3-91), the median, 12- and 18-month locoregional control (LRC) was not reached/72%/68%; distant control (DC) was not reached/60%/54%; and overall survival (OS) was 39 months/67%/57%. On UVA, smokers (p=0.006) and NACT (p=0.03) had improved LRC; smokers (p=0.031) and no LVSI (p=0.037) had improved DC; smokers (p=0.031), ypT0/T0is (p=0.015), no LVSI (p=0.003), and no ECE (p=0.002) had improved OS. Gender, clinical stage, percent SmCCB/NE, P/E vs other CT, margin status, PNI, and all therapies (NACT, surgery, XRT, ACT) had no influence on OS. On MVA no variable remained predictive. Even in a modern series of SmCCB/NE, prognoses remain poor. However, NACT can successfully induce pCR, improving survival. Survival otherwise doesn’t seem influenced by any specific treatment regimen. Although prospective validation is needed, adverse surgical features, including LVSI or ECE should prompt consideration of adjuvant therapy. As with other small cell carcinomas, novel therapies, such as immunotherapy, may improve outcomes.

Small cell carcinoma of the bladder with coexisting prostate adenocarcinoma: two cases report and literature review

BackgroundPrimary small cell carcinoma of the bladder (SCCB) is a rare disease of the genitourinary tract and reported limitedly. SCCB is very aggressive and always mixed with other histologic components, but coexistence of SCCB and prostate adenocarcinoma is extremely rare.Cases presentationTwo aged males (72 and 58 years) were included in this study. Both of them presented with gross hematuria as initial symptom. Magnetic resonance imaging (MRI) demonstrated protruding lesions in the urinary bladder. Pathological examination after radical cystectomy and prostatectomy showed the concurrence of SCCB and prostate adenocarcinoma. One patient died of liver and lung metastasis 8 months after surgery, and the other patient was still alive after 19 months of follow-up.ConclusionIn this paper, we reported two unusual cases of coexistence of SCCB and prostate adenocarcinoma, and reviewed relative literatures with respect to the epidemiology, clinical features, pathologic features, diagnosis, treatment and prognosis of SCCB.