Instructor of Urology Vanderbilt University Medical Center
Introduction: Small cell carcinoma of the bladder remains a rare yet rapidly progressive and fatal disease. We examined patients with localized small cell carcinoma of the bladder in the National Cancer Database (NCDB) and assessed differences in survival based upon treatment modality received. We hypothesized that chemotherapy and radical cystectomy (CT + RC) would offer superior survival to transurethral resection of bladder tumor (TURBT) alone, radical cystectomy alone (RC), or a bladder preservation strategy with transurethral resection and chemotherapy with or without radiation (BPS).
Methods: We queried the National Cancer Database from 2004 to 2016 for all cases of small cell bladder cancer using International Classification of Disease-O-3 morphologic codes 8013, 8041, 8044, 8045 and 8246. We then identified patients who received treatment. Our primary outcome was overall survival while secondary outcomes included identifying treatment patterns. Demographic and staging information was recorded. Kaplan-Meier analysis of estimated survival was calculated. Cox proportional hazard modeling was performed.
Results: 2298 patients met initial inclusion criteria. However, treatment details were unknown in 384 patients. Thus, 1914 patients met criteria for analysis. 76.6% of patients were male while 23.4% were female 91.7% of patients were white, with 6.1% identified as Black/African American. The most common clinical stage was cT2, n=841 (43.9%), followed by cT1 in 315 patients (16.5%). 523 patients received TURBT alone and estimated survival was 26.3 months. 830 patients underwent BPS, with an estimated survival of 46 months. RC alone was performed in 155 patients with an estimated survival of 28 months. CT + RC was performed in 407 patients; estimated survival was greatest at 66 months. On multivariable analysis, patients who underwent CT+RC had lower hazards of death compared to those who received BPS (HR 0.756, 95% CI 0.604 - 0.946).
Conclusions: A combination of multimodal therapy with initial TURBT for diagnosis followed by chemotherapy and radical cystectomy conferred the greatest survival in this cohort of patients with a rare diagnosis. This finding supports current recommendations from the American Urological Association/Society of Urologic Oncology guidelines for Treatment of non-metastatic muscle invasive bladder cancer to consider multimodal therapy for this variant histology with NAC + RC.
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