title: Radical cystectomy for primary neuroendocrine tumors of the bladder: the university of southern california experience.
abstract: OBJECTIVE
  Primary neuroendocrine tumors of the bladder are rare and they include small and large cell variants. We reviewed our experience with treating these tumors with radical cystectomy to evaluate their histopathological characteristics and clinical outcomes.
  
  
  METHODS
  From August 1971 to June 2004, 2,005 patients underwent radical cystectomy for primary bladder cancer at our institution, of whom 25 (1.2%) had neuroendocrine tumors of the bladder, including small cell carcinoma in 20 and large cell carcinoma in 5. Pure neuroendocrine-type histology was identified in 16 cases, including 1 with small and large cell features, while the remaining 9 had mixed histology, that is transitional cell carcinoma in 8 and adenocarcinoma in 1. Multi-agent chemotherapy was administered to 14 patients.
  
  
  RESULTS
  Median patient age was 68 years (range 40 to 82) and 19 patients were male (76%). A total of 19 patients (76%) had lymph node involvement, of whom 2 had small liver metastases found intraoperatively, while only 4 (16%) had organ confined tumors and 2 (8%) had extravesical, node negative disease. These tumors tended to have a flat, ulcerative gross appearance with lymphovascular invasion, carcinoma in situ and necrosis present microscopically. Median followup was 11.8 years (range 18 days to 15.1 years). Five-year overall and recurrence-free survival was 10% and 13%, respectively. There was no significant survival difference between small and large cell carcinoma. Mixed histologies tended to do better than pure neuroendocrine tumors, although this did not attain statistical significance (p = 0.064). Patients receiving multimodality therapy had significantly better overall (p = 0.051) and recurrence-free (p = 0.003) survival than those treated with cystectomy alone.
  
  
  CONCLUSIONS
  Neuroendocrine tumors of the bladder usually present with advanced pathological stage and portend a poor prognosis. Adjuvant chemotherapy protocols may provide improved survival compared with cystectomy alone.
authors.affiliation: Departments of Urology, Keck School of Medicine, University of Southern California, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, California, USA. quekm@hsc.usc.edu
authors.forename: Marcus L
authors.initials: ML
authors.lastname: Quek
authors.forename: Peter W
authors.initials: PW
authors.lastname: Nichols
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yamzon
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.forename: Susan
authors.initials: S
authors.lastname: Groshen
authors.forename: John P
authors.initials: JP
authors.lastname: Stein
authors.forename: Donald G
authors.initials: DG
authors.lastname: Skinner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*