Neuroendocrine carcinoma of the bladder (NEC-bladder) is a rare disease with poor outcomes and variable treatment approaches.
Patients with localized NEC-bladder treated with surgery or radiation between 2001-2021 were retrospectively identified. Rates of pathologic complete response (pCR) and downstaging were evaluated following NAC in surgically-treated patients. Progression-free survival (PFS) and overall survival (OS) were analyzed with univariable (log-rank) and multivariable (MVA; Cox regression) methods.
Sixty-five patients were identified having a median age of 73. The tumor histology distribution was small cell (64.6%) or urothelial with NE differentiation (35.4%). Most patients (69.2%) received NAC. Patients received local therapy by surgery (78.5%) or chemoradiation (21.5%). The majority (62.7%) of surgical patients had ≥ pT2 with 37.3% having nodal involvement (pN+). The pCR and downstaging rates were 21.6% and 35.1%, respectively. At a median follow-up of 60 months (m), the median PFS and OS were 16.4m and 25.9m, respectively. NAC improved PFS (p=0.04) and downstaging improved PFS (p=0.012) and OS (p<0.001). Patients receiving NAC with ypN0 vs. ypN+ had median OS of 69.9m vs 15.3m, respectively (p<0.001). MVA identified receipt of NAC and pN as predictors of PFS; pN was predictive of OS. No differences in PFS or OS were seen between histology of primary tumor. The brain metastasis rate was 10.8% with all patients having small cell histology.
Optimized therapy in NEC-bladder includes NAC followed by local consolidation. Ascertainment of ypN0 is associated with long term survival, while pN+ remains associated with poor outcomes.
Clinical genitourinary cancer. 2024 Sep 07 [Epub ahead of print]
Casey Liveringhouse, Austin J Sim, Jingsong Zhang, Rohit K Jain, Shreyas U Naidu, Lauren Linkowski, Logan W Zemp, Alice Yu, Wade J Sexton, Philippe E Spiess, Scott M Gilbert, Michael A Poch, Julio Pow-Sang, Roger Li, Brandon J Manley, Aram Vosoughi, Jasreman Dhillon, Hongzhi Xu, Javier F Torres-Roca, Peter A S Johnstone, Kosj Yamoah, G Daniel Grass
Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Deparment of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., College of Arts and Sciences, University of South Florida, Tampa, FL., Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA., Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa FL., Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL. Electronic address: .