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Clinical Outcomes of Small Cell Carcinoma of the Bladder
Jairam R. Eswara, MD, Niall M. Heney, MD, Chin-Lee Wu, MD, PhD, W. Scott McDougal, MD.
Massachusetts General Hospital, Boston, MA, USA.
BACKGROUND:Small cell carcinoma of the bladder is an uncommon but clinically aggressive entity. There is no standard surgical or medical management for the disease. The purpose of this study is to report the clinical characteristics and management of this disease.
METHODS:Between 1995 and 2009, 29 patients underwent TURBT or cystectomy, chemotherapy, and/or radiation for small cell carcinoma of the bladder at our institution. Data was retrospectively gathered from the electronic medical records.
RESULTS:In this series, 29 patients received treatment for small cell carcinoma of the bladder with a median follow up for survivors of 34 months. Patients presented most often with muscle-invasive disease (Stage I - 10%, II - 55%, III - 10%, IV - 24%) and 21% had metastases. Tobacco use and chemical exposures were noted in 64% and 3% of patients, respectively.
Treatment included the following: chemotherapy alone (5, 17%), cystectomy alone (6, 21%), radiation alone (1, 3%), chemotherapy and cystectomy (5, 17%), chemotherapy and radiation (1, 3%), and chemotherapy, radiation, and cystectomy (3, 10%).
There was no statistical difference in survival between patients who underwent surgery (p=0.41), chemotherapy (p=0.67), or radiation (p=0.70). There was a difference in survival between stages 1-2 and 3-4 with a median survival of 44 months and 12 months, respectively (p=0.05). The median time to recurrence was 8 months, median survival was 14 months, and 5-year survival was 13%.
CONCLUSIONS:Small cell carcinoma of the bladder is an aggressive disease with poor outcomes. In this series, patients with small cell of the bladder had a median time to recurrence of 8 months and median survival of 14 months.
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