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

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Justin Oh ◽  
Bernhard Eigl ◽  
Peter C. Black ◽  
Tom Pickles ◽  
Carlos Villamil ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Treatment Options ◽  
Eastern Cooperative Oncology Group ◽  
Multivariable Analysis ◽  
Population Based ◽  
Small Cell ◽  
Cancer Specific Survival ◽  
Curative Intent ◽  
Cell Bladder Cancer ◽  
Carcinoma Of The Bladder

Introduction: We aimed to describe the oncological outcomes after radical cystectomy and chemo-radiation for localized small cell bladder cancer (SCBC). Methods: 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. Results: 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 (NACHT) 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. Conclusions: 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. NACHT should be considered for eligible patients. Both chemoRT and RC treatment options should be discussed with patients with SCBC.

Outcomes of radical cystectomy in potential candidates for bladder-preservation therapy.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 357-357
Author(s):  
Eugene J. Pietzak ◽  
Zachary L. Smith ◽  
S. Bruce Malkowicz ◽  
Thomas J. Guzzo
Keyword(s):  
Radical Cystectomy ◽  
Treatment Options ◽  
Distant Recurrence ◽  
Bladder Preservation ◽  
Clinicopathologic Characteristics ◽  
Cancer Specific Survival ◽  
Curative Intent ◽  
Academic Center ◽  
Mixed Histology

357 Background: Outcomes for Bladder Preservation Therapy (BPT) in urothelial-type bladder cancer (UBC) are often compared to those achieved by Radical Cystectomy (RC). However, BPT patients are usually “carefully selected” which may limit comparisons. Our objective was to analyze the outcomes of RC within a “carefully selected” patient cohort. Methods: We identified 471 consecutive patients with UBC who underwent RC with curative intent from 1987 to 2008 at a single academic center. Patients were considered eligible for BPT if tumors were clinical T2 without carcinoma in-situ (CIS), hydronephrosis, multiple invasive tumors, or mixed histology. Patients with ≥1 contraindications were considered ineligible. Renal function was not factored into eligibility. Clinicopathologic characteristics and survival outcomes for BPT eligible patients were compared to ineligible patients. Results: 275 patients had cT2 tumors, of which 157 (57.1%) were ineligible for BPT (CIS=54; hydro=77; multiple tumors=29; mixed histology=55; ≥2 contraindications=51). BPT eligible and ineligible patients did not statistically differ with regards to age, gender, race, BMI, smoking, ASA score, or neoadjuvant chemotherapy. At time of RC, BPT eligible patients were less likely to have positive lymph nodes (p=0.01), pathologic LVI (p=0.02), & upstaging to pT3/pT4 (p=0.002). 2 and 5 year overall survival (OS) for all cT2 patients was 65.2% and 40.3%. 2 and 5 year OS was 76.7% and 44.2% for BPT eligible patients, but only 57.1% and 37.4% for ineligible (p=0.07). No statistical difference was seen in distant Recurrence Free Survival (RFS) (p=0.9), but BPT eligible patients had better local-RFS (p=0.05). 2-year Cancer Specific Survival (CSS) for all cT2, BPT eligible, and BPT ineligible patients was 71.8, 85.4%, and 62.3% respectively. Fine-Gray competing risk analysis revealed significantly better CSS for BPT eligible patients compared to those ineligible (Sub-HR=0.46 [CI=0.29-0.72] p=0.001). Conclusions: RC provides excellent CSS for patients potentially eligible for BPT. This should be included in an informed discussion of treatment options. In the absence of randomized trials, comparisons between RC and BPT must factor in selection bias.

scholarly journals Tumor cell invasion in blood vessels assessed by immunohistochemistry is related to decreased survival in patients with bladder cancer treated with radical cystectomy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Birgitte Carlsen ◽  
Tor Audun Klingen ◽  
Bettina Kulle Andreassen ◽  
Erik Skaaheim Haug
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Regional Lymph Node ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Population Based ◽  
Blood Vessel Invasion ◽  
Curative Intent ◽  
Regional Lymph Nodes ◽  
Pathological Stages

Abstract Background Lymphovascular invasion (VI) is an established prognostic marker for many cancers including bladder cancer. There is a paucity of data regarding whether the prognostic significance of lymphatic invasion (LVI) differs from blood vessel invasion (BVI). The aim was to examine LVI and BVI separately using immunohistochemistry (IHC), and investigate their associations with clinicopathological characteristics and prognosis. A secondary aim was to compare the use of IHC with assessing VI on standard HAS (hematoxylin-azophloxine-saffron) sections without IHC. Methods A retrospective, population –based series of 292 invasive bladder cancers treated with radical cystectomy (RC) with curative intent at Vestfold Hospital Trust, Norway were reviewed. Traditional histopathological markers and VI based on HAS sections were recorded. Dual staining using D2–40/CD31 antibodies was performed on one selected tumor block for each case. Results The frequency of LVI and BVI was 32 and 28%, respectively. BVI was associated with features such as higher pathological stages, positive regional lymph nodes, bladder neck involvement and metastatic disease whereas LVI showed weaker or no associations. Both BVI and LVI independently predicted regional lymph node metastases, LVI being the slightly stronger factor. BVI, not LVI predicted higher pathological stages. BVI showed reduced recurrence free (RFS) and disease specific (DSS) survival in uni-and multivariable analyses, whereas LVI did not. On HAS sections, VI was found in 31% of the cases. By IHC, 51% were positive, corresponding to a 64% increased sensitivity in detecting VI. VI assessed without IHC was significantly associated with RFS and DSS in univariable but not multivariable analysis. Conclusions Our findings indicate that BVI is strongly associated with more aggressive tumor features. BVI was an independent prognostic factor in contrast to LVI. Furthermore, IHC increases VI sensitivity compared to HAS.

Long-Term Outcomes of Organ Preservation in Patients with Small Cell Carcinoma of the Bladder

2015 ◽  
Vol 94 (4) ◽  
pp. 401-405 ◽  
Author(s):  
Jairam R. Eswara ◽  
Niall M. Heney ◽  
Chin-Lee Wu ◽  
W. Scott McDougal
Keyword(s):  
Cell Carcinoma ◽  
Small Cell Carcinoma ◽  
Metastatic Disease ◽  
Advanced Disease ◽  
Chemical Exposure ◽  
Small Cell ◽  
Cancer Specific Survival ◽  
Entire Cohort ◽  
Aggressive Disease ◽  
Carcinoma Of The Bladder

Background: Small cell carcinoma of the bladder is an uncommon but clinically aggressive disease. There is no standard surgical or medical management for the disease. Methods: Between 1995 and 2009, 28 patients underwent transurethral resection (TUR) and/or cystectomy, chemotherapy, and/or radiation for small cell carcinoma of the bladder at our institution. Results: The median follow-up for survivors was 34 months. Patients presented most often with muscle-invasive disease (T2-4 - 89%), and 21% had lymph node/distant metastases. Tobacco use and chemical exposure were noted in 64 and 4% of patients, respectively. Patients with T1-2N0M0 had a median survival of 22 months compared to 8 months for those with more advanced disease (p = 0.03). Patients with T3-4 or nodal/metastatic disease who were given chemotherapy had an improved survival compared to those with T3-4 or nodal/metastatic disease who did not undergo chemotherapy (13 vs. 4 months, p = 0.005). The median time to recurrence of the entire cohort was 8 months, overall and cancer-specific survival was 14 months, and 5-year survival was 11%. Conclusions: Small cell carcinoma of the bladder is an aggressive disease with poor outcomes. Patients with T1-2N0M0 disease survived longer than those with advanced disease. Patients with T3-4 or nodal/metastatic disease had improved survival with chemotherapy.

scholarly journals A Case of Primary Small-Cell Carcinoma of the Bladder

2016 ◽  
Vol 9 (3) ◽  
pp. 574-579 ◽  
Author(s):  
Ashita Ono ◽  
Yosuke Hirasawa ◽  
Mitsumasa Yamashina ◽  
Naoto Kaburagi ◽  
Takashi Mima ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Cell Carcinoma ◽  
Radical Cystectomy ◽  
Small Cell Carcinoma ◽  
Distant Metastasis ◽  
Small Cell ◽  
Common Type ◽  
Cell Of Origin ◽  
Carcinoma Of The Bladder

Primary small-cell carcinoma arising from the bladder (SmCCB) is uncommon. It differs from urothelial carcinoma (UC), the most common type of bladder cancer, with respect to its cell of origin, biology, and prognosis. Biologically, prostatic SmCCB is much more aggressive than UC, and the prognosis for cases with distant metastasis is especially poor. We report here a case of primary SmCCB (cT3bN1M0) treated with radical cystectomy.

Cancer-specific survival in patients with urothelial carcinoma of the bladder with recurrence after radical cystectomy: External validation of the prognostic risk stratification model.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 325-325 ◽  
Author(s):  
Tohru Nakagawa ◽  
Haruki Kume ◽  
Atsushi Kanatani ◽  
Masaomi Ikeda ◽  
Akihiko Matsumoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Median Survival ◽  
Prognostic Value ◽  
Risk Group ◽  
Cancer Specific Survival ◽  
Poor Risk ◽  
Carcinoma Of The Bladder ◽  
Metastatic Sites

325 Background: Prognosis of the patients with urothelial carcinoma of the bladder (UCB) who developed recurrence after radical cystectomy (RC) is generally poor, but can be variable. We previously showed that shorter time to recurrence (TTR) after RC, presence of symptoms on recurrence, more than one metastatic sites (organs), high serum C-reactive protein (CRP) level were associated with decreased survival in those patients, and proposed a model to stratify patients into 3 separate risk groups (Nakagawa et al. J Urol. 2013; 189:1275). The aim of this study was to evaluate the prognostic value of this model in a multi-institutional cohort of patients. Methods: We identified 267 patients who experienced disease recurrence after RC for UCB from 9 academic and community hospitals. Patients were categorized into three groups based on the presence of four risk factors, TTR of <1 year, presence of symptoms on recurrence, more than one metastatic sites (organs), and CRP level of ≥0.5 mg/dl: the favourable risk group included patients with none or one of these risk factors; the intermediate risk group with 2 risk factors; and those with 3 or 4 risk factors were assigned to the poor risk group. Results: Overall, median survival time (MST) of the entire cohort was 8.3 months (95%CI, 6.4-9.1). Two hundred and nineteen patients died of their disease with a median survival of 5.9 months. In a multivariate analysis, all of the 4 risk factors were statistically significant for the cancer-specific survival. Sixty-five (27.4%), 84 (35.4%), and 88 (37.1%) patients were in the favorable, intermediate and poor risk group, respectively. Thirty patients were excluded because CRP value was not obtained. MSTs of the patients in the favorable, intermediate and poor risk group were 22.2 (95% CI 16.1-28.3), 7.6 (95% CI 6.3-9.5), and 3.6 (95% CI 2.6-4.4) months, respectively, and the difference was statistically significant (p<0.001, log-rank test). Conclusions: We confirmed the prognostic value of our previous criteria based on the four variables in patients with recurrence after RC for UCB. This criteria would help in patient counseling and clinical trial design.

Small cell bladder cancer: Treatment patterns and clinical outcomes.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17014-e17014
Author(s):  
Rishi Robert Sekar ◽  
Leonidas Nikolaos Diamantopoulos ◽  
Funda Vakar-Lopez, MD ◽  
Petros Grivas ◽  
Sarah P. Psutka ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Univariate Analysis ◽  
Pathologic Complete Response ◽  
Multivariable Analysis ◽  
Complete Response ◽  
Small Cell ◽  
Oncologic Outcomes ◽  
Rank Test ◽  
Definitive Therapy ◽  
Cell Bladder Cancer

e17014 Background: Small cell bladder cancer (SCBC) is a rare histologic variant associated with poor oncologic outcomes and propensity for metastasis, however, there remains a paucity of data regarding the role of chemoradiation. We review our institutional experience of patients with small cell bladder cancer (SCBC) treated with radical cystectomy (RC) versus concurrent chemoradiotherapy (CCRT). Methods: We retrospectively reviewed our institutional database for pts with SCBC treated with RC or CCRT and compared them to pts with conventional urothelial carcinoma (CUC) treated with RC. Clinicopathologic data and outcomes were captured and compared between treatment groups. Overall (OS) and recurrence-free survival (RFS) were estimated utilizing the Kaplan Meier method. T test, χ2 test and log-rank test were used for group comparisons. Factors significant in the univariate analysis for OS were included in multivariable Cox models. Results: We identified 38 consecutive pts with SCBC, of whom 24 (63%) had SC predominant ( > 50%) histology. At presentation, 31 (82%) had muscle invasion, 8 (22%) had nodal involvement, and 7 (18%) had distant metastasis. Twenty-eight (73%) pts proceeded to definitive therapy, with RC in 20 (53%) and CCRT in 8 (21%). Among pts treated with CCRT, 4 (50%) had complete response on cystoscopy, 2 (25%) had residual disease with 1 (12.5%) proceeding to salvage cystectomy, and 2 (25%) progressed with metastasis. Among pts treated with RC, 15 (75%) received neoadjuvant chemotherapy (NAC) with platinum/etoposide, of whom 3 (20%) experienced a pathologic complete response (pCR, ypT0N0), 3 (20%) had residual UC but no SCBC, and 9 (60%) had residual SCBC. Median OS was comparable between RC and CCRT groups (30.4 vs. 26.2 months, p = 0.633). Compared to pts with CUC treated with RC (n = 457), those with SCBC treated with RC had similar clinical stage, rates of carcinoma in situ, lymphovascular invasion, and positive surgical margins (all p > 0.05). Median OS and RFS were inferior for SCBC treated with RC (30.4 vs 109.7 months, p = .001; 13.1 vs 86.1 months, p = .002). On multivariable analysis among pts treated with RC, SCBC was significantly associated with shorter OS adjusting for pT and pN stage, performance status, and age. Conclusions: Pts with SCBC undergoing RC had significantly worse oncologic outcomes compared to pts with CUC, however RC and CCRT had comparable outcomes in pts with SCBC. The pCR rate to NAC was unexpectedly low. Larger sample size, assessment of other confounders and longer follow-up are needed for validation.

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