Small cell bladder cancer (SCBC) is a rare histologic subtype with relative paucity of data regarding treatment response and outcomes. We reviewed 2 databases to compare outcomes in patients with localized SCBC treated with cystectomy versus concurrent chemoradiotherapy (CCRT). We hypothesized that survival would be similar with these therapy approaches.
We retrospectively reviewed our institutional and SEER-Medicare databases to identify patients with SCBC. Overall survival (OS) was determined from the date of diagnosis to last follow-up/death. For those with nonmetastatic disease, a multivariate Cox analysis was used to compare locoregional therapy with neoadjuvant chemotherapy (NAC) + cystectomy versus CCRT.
We identified 53 patients in our institutional database and 1166 patients in SEER-Medicare with localized SCBC. Median OS (mOS) with NAC + cystectomy was 46 months (95% CI, 21-72) and 45 months (95% CI, 0-104) in the institutional and SEER-Medicare databases, respectively, whereas mOS with CCRT was 26 months (95% CI, 5-47) and 23 months (95% CI, 18-28) in the 2 series, respectively. In multivariate analysis, NAC followed by cystectomy was associated with an approximately 30% reduction in mortality compared to CCRT in both institutional and national databases but did not reach statistical significance (Institution HR 0.71, 95% CI, 0.22-2.4, P = .58; SEER HR 0.73, 95% CI, 0.49-1.08; P = .11).
SCBC is very aggressive with limited survival observed in our institutional and SEER-Medicare datasets regardless of locoregional therapy used. There is an unmet need to define the optimal locoregional therapy for nonmetastatic stage and identify novel therapeutic targets.
Clinical genitourinary cancer. 2024 Aug 22 [Epub ahead of print]
Dimitra Rafailia Bakaloudi, Elizabeth L Koehne, Leonidas N Diamantopoulos, Sarah K Holt, Rishi R Sekar, Fady Ghali, Funda Vakar-Lopez, Yaw A Nyame, Sarah P Psutka, John L Gore, Claire M de la Calle, Daniel W Lin, George R Schade, Jay J Liao, Andrew C Hsieh, Todd Yezefski, Jessica E Hawley, Evan Y Yu, R Bruce Montgomery, Petros Grivas, Jonathan L Wright
Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA. Electronic address: ., Department of Urology, University of Washington, Seattle, WA., Department of Hematology/Oncology, Mayo Clinic, Rochester, MΝ., Department of Urology, University of Michigan, Michigan, MI., Department of Urology, Yale School of Medicine, New Haven, CT., Department of Pathology, University of Washington, Seattle, WA., Department of Urology, University of Washington, Seattle, WA; Division of Clinical Research Fred Hutchinson Cancer Center, Seattle, WA., Department of Radiation Oncology, University of Washington, Seattle, WA., Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA; Division of Human Biology, Fred Hutchinson Cancer Center, Seattle, WA., Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA., Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA; Division of Clinical Research Fred Hutchinson Cancer Center, Seattle, WA.