Baylor College of Medicine, Houston, Texas, USA.
Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):64-70. doi: 10.1016/j.ijrobp.2011.05.039. Epub 2011 Oct 20.
Treatment for small-cell carcinoma of the bladder is largely guided by case reports, retrospective reviews, and small prospective trials. This study aimed to study outcomes using a large population-based database.
The Surveillance, Epidemiology, and End Results-Medicare database (1991-2005) was used to analyze how different treatment combinations of specific bladder surgeries, chemotherapy, and radiation affected patient outcomes. Trends in the use of these combinations over time were also analyzed.
A total of 533 patients were retrieved from the database. A bladder-sparing approach involving transurethral resection of the bladder tumor (TURBT) combined with chemotherapy and radiation yielded no significant difference in overall survival compared with patients undergoing at least a cystectomy (of whom over 90% received radical cystectomy) with chemotherapy (p > 0.05). The analysis of treatment trends indicated that these two general strategies for cure combined to account for fewer than 20% of patients. A majority of patients (54%) received TURBT as their only surgical treatment, and a subset analysis of these patients indicated that chemotherapy played a role in all stages of disease (p < 0.05) whereas radiation improved overall survival in regional-stage disease (p < 0.05).
Relatively few patients with small-cell carcinoma of the bladder receive potentially curative therapies. Chemotherapy should be a major component of treatment. Cystectomy and bladder-sparing approaches represent two viable strategies and deserve further investigation to identify the patients who may benefit from organ preservation or not. In addition, the role of radiation in regional-stage disease should be investigated further, because it positively affects survival after TURBT.
治疗膀胱小细胞癌主要依据病例报告、回顾性研究和小规模前瞻性试验。本研究旨在利用大型基于人群的数据库来研究结局。
利用监测、流行病学和最终结果-医疗保险数据库（1991-2005 年）分析特定的膀胱手术、化疗和放疗的不同联合治疗组合如何影响患者的结局。还分析了这些组合随时间的使用趋势。
从数据库中检索到 533 例患者。与接受化疗的至少行根治性膀胱切除术（其中 90%以上患者接受根治性膀胱切除术）的患者相比，经尿道膀胱肿瘤切除术（TURBT）联合化疗和放疗的保膀胱方法在总体生存方面无显著差异（p＞0.05）。治疗趋势分析表明，这两种治愈的一般策略结合起来，不到 20%的患者接受了治疗。大多数患者（54%）仅接受 TURBT 作为其唯一的手术治疗，对这些患者的亚组分析表明，化疗在疾病的各个阶段都发挥了作用（p＜0.05），而放疗改善了局部阶段疾病的总体生存（p＜0.05）。
相对较少的膀胱小细胞癌患者接受潜在的治愈性治疗。化疗应成为治疗的主要组成部分。根治性膀胱切除术和保膀胱方法代表两种可行的策略，值得进一步研究以确定哪些患者可能受益于器官保留或不保留。此外，还应进一步研究放疗在局部阶段疾病中的作用，因为它可积极影响 TURBT 后的生存。
