title: Small Cell Carcinoma of the Urinary Bladder: A Retrospective, Multicenter Rare Cancer Network Study of 107 Patients.
abstract: OBJECTIVE
  Small cell carcinomas of the bladder (SCCB) account for fewer than 1% of all urinary bladder tumors. There is no consensus regarding the optimal treatment for SCCB.
  
  
  METHODS
  Fifteen academic Rare Cancer Network medical centers contributed SCCB cases. The eligibility criteria were as follows: pure or mixed SCC; local, locoregional, and metastatic stages; and age ≥18 years. The overall survival (OS) and disease-free survival (DFS) were calculated from the date of diagnosis according to the Kaplan-Meier method. The log-rank and Wilcoxon tests were used to analyze survival as functions of clinical and therapeutic factors.
  
  
  RESULTS
  The study included 107 patients (mean [±standard deviation, SD] age, 69.6 [±10.6] years; mean follow-up time, 4.4 years) with primary bladder SCC, with 66% of these patients having pure SCC. Seventy-two percent and 12% of the patients presented with T2-4N0M0 and T2-4N1-3M0 stages, respectively, and 16% presented with synchronous metastases. The most frequent curative treatments were radical surgery and chemotherapy, sequential chemotherapy and radiation therapy, and radical surgery alone. The median (interquartile range, IQR) OS and DFS times were 12.9 months (IQR, 7-32 months) and 9 months (IQR, 5-23 months), respectively. The metastatic, T2-4N0M0, and T2-4N1-3M0 groups differed significantly (P=.001) in terms of median OS and DFS. In a multivariate analysis, impaired creatinine clearance (OS and DFS), clinical stage (OS and DFS), a Karnofsky performance status <80 (OS), and pure SCC histology (OS) were independent and significant adverse prognostic factors. In the patients with nonmetastatic disease, the type of treatment (ie radical surgery with or without adjuvant chemotherapy vs conservative treatment) did not significantly influence OS or DFS (P=.7).
  
  
  CONCLUSIONS
  The prognosis for SCCB remains poor. The finding that radical cystectomy did not influence DFS or OS in the patients with nonmetastatic disease suggests that conservative treatment is appropriate in this situation.
authors.affiliation: Academic Radiation Oncology Department, Centre Oscar Lambret, Lille, France. Electronic address: d-pasquier@o-lambret.fr.
authors.forename: David
authors.initials: D
authors.lastname: Pasquier
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Brandon
authors.initials: B
authors.lastname: Barney
authors.affiliation: Department of Oncology, Nottingham University Hospitals National Health Service Trust, Nottingham, UK.
authors.forename: Santhanam
authors.initials: S
authors.lastname: Sundar
authors.affiliation: Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Philip
authors.initials: P
authors.lastname: Poortmans
authors.affiliation: Radiation Oncology, Catalan Institute of Oncology, H. Universitari Germans Trías, Badalona, Barcelona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Villa
authors.affiliation: Division of Oncology, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Haitam
authors.initials: H
authors.lastname: Nasrallah
authors.affiliation: Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Noureddine
authors.initials: N
authors.lastname: Boujelbene
authors.affiliation: Department of Radiation Oncology, Bern University Hospital, Bern, Switzerland.
authors.forename: Pirus
authors.initials: P
authors.lastname: Ghadjar
authors.affiliation: Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Lassen-Ramshad
authors.affiliation: Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Senkus
authors.affiliation: Genesis Cancer Care, Southport, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Oar
authors.affiliation: Institut Jules Bordet, Brussels, Belgium.
authors.forename: Martine
authors.initials: M
authors.lastname: Roelandts
authors.affiliation: Provincial Agency for Proton Therapy, Trento, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Amichetti
authors.affiliation: Department of Radiation Oncology, Hopital de Sion, Sion, Switzerland.
authors.forename: Hansjoerg
authors.initials: H
authors.lastname: Vees
authors.affiliation: Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zilli
authors.affiliation: Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Ozsahin
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018288:Carcinoma, Small Cell / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D003404:Creatinine / Q000378:metabolism; D015653:Cystectomy / Q000379:methods / Q000401:mortality; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D015999:Multivariate Analysis; D035583:Rare Diseases / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D014555:Urination Disorders / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents; D003404:Creatinine