Treatment outcomes for small cell carcinoma of the bladder : results from a UK patient retrospective cohort study
Chau, Caroline Rimmer Frcr, Yvonne Choudhury PhD, Ananya Leaning Frcr, Darren Law, Alastair Enting, Deborah Lim Md, Jun Hao Hafeez PhD, Shaista Khoo PhD, Vincent Huddart PhD, Robert
Chau, Caroline
Rimmer Frcr, Yvonne
Choudhury PhD, Ananya
Leaning Frcr, Darren
Law, Alastair
Enting, Deborah
Lim Md, Jun Hao
Hafeez PhD, Shaista
Khoo PhD, Vincent
Huddart PhD, Robert
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2021-02-06
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Abstract
Purpose: 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.
Methods and materials: 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.
Results: 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.
Conclusions: 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.
Citation
Chau C, Rimmer Frcr Y, Choudhury PhD A, Leaning Frcr D, Law A, Enting D, Lim Md JH, Hafeez PhD S, Khoo PhD V, Huddart PhD R, Mitchell Frcr D, Henderson Frcr DR, McGrane Frcr J, Beresford Frcr M, Vasudev PhD N, Beesley Frcr S, Hilman S, Manetta Frcr C, Sriram Frcs R, Sharma Md A, Eswar Frcr C, Treece Frcr S, Vilarino-Varela Frcr M, Varughese Frcr M, Glen PhD H, Pintus Md E, Crabb PhD S. Treatment Outcomes for Small Cell Carcinoma of the Bladder: Results From a UK Patient Retrospective Cohort Study. Int J Radiat Oncol Biol Phys. 2021 Jul 15;110(4):1143-1150. doi: 10.1016/j.ijrobp.2021.02.003. Epub 2021 Feb 6
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Article