title: Long-term outcomes of organ preservation in patients with small cell carcinoma of the bladder.
abstract: 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.
authors: Department of Urology, Massachusetts General Hospital, Boston, Mass., USA.
authors: Jairam R
authors: JR
authors: Eswara
authors: Niall M
authors: NM
authors: Heney
authors: Chin-Lee
authors: CL
authors: Wu
authors: W Scott
authors: WS
authors: McDougal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D018288:Carcinoma, Small Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000401:mortality; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D055815:Young Adult