Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
J Urol. 2014 Feb;191(2):329-34. doi: 10.1016/j.juro.2013.09.009. Epub 2013 Sep 12.
Because small cell carcinoma of the bladder is a relatively rare tumor type, literature about its treatment remains limited. We determined patterns of care and survival after treatment in what is to our knowledge the largest series to date of patients with locoregional small cell carcinoma of the bladder.
We identified patients with localized/locally advanced (cTis-cT4, cN0 or cM0) bladder small cell carcinoma diagnosed between 1998 and 2010 from the National Cancer Database (NCDB). Treatment was categorized as bladder preservation therapy, radical cystectomy alone, bladder preservation therapy with multimodal treatment or radical cystectomy plus multimodal treatment. We performed Kaplan-Meier overall survival analysis to evaluate differential survival between treatment groups.
A total of 625 patients met study inclusion criteria. Median age at diagnosis was 73 years (range 36 to 90) and 65% of patients presented with cT2 disease. Patients were treated with bladder preservation therapy (174 or 27.8%), bladder preservation therapy plus multimodal treatment (333 or 53.3%), radical cystectomy alone (46 or 7.4%) and radical cystectomy plus multimodal treatment (72 or 11.5%) with a 3-year overall survival rate of 23% (95% CI 15-32), 35% (95% CI 30-45), 38% (95% CI 17-60) and 30.1% (95% CI 16-47), respectively. Overall survival was most favorable for radical cystectomy alone plus neoadjuvant chemotherapy with a 3-year rate of 53% (95% CI 19-79).
In the United States locoregional small cell carcinoma of the bladder develops predominantly in white males, in whom treatment is performed at metropolitan, comprehensive community cancer centers. Most patients were treated with bladder preservation therapy and most received multimodal therapy. Patients who received neoadjuvant chemotherapy followed by radical cystectomy had the most favorable survival.
由于膀胱小细胞癌是一种相对罕见的肿瘤类型，因此关于其治疗的文献仍然有限。我们确定了治疗模式和生存情况，这是迄今为止我们所知的最大系列局部区域膀胱小细胞癌患者的研究。
我们从国家癌症数据库（NCDB）中确定了 1998 年至 2010 年间诊断为局限性/局部晚期（Tis-cT4、N0 或 M0）膀胱小细胞癌的患者。治疗分为膀胱保留治疗、单纯根治性膀胱切除术、膀胱保留治疗联合多模式治疗或根治性膀胱切除术联合多模式治疗。我们进行了 Kaplan-Meier 总体生存分析，以评估治疗组之间的差异生存。
共有 625 名患者符合研究纳入标准。中位诊断年龄为 73 岁（范围为 36 至 90 岁），65%的患者患有 T2 期疾病。患者接受了膀胱保留治疗（174 例或 27.8%）、膀胱保留治疗联合多模式治疗（333 例或 53.3%）、单纯根治性膀胱切除术（46 例或 7.4%）和根治性膀胱切除术联合多模式治疗（72 例或 11.5%），3 年总生存率分别为 23%（95%CI 15-32）、35%（95%CI 30-45）、38%（95%CI 17-60）和 30.1%（95%CI 16-47）。单纯根治性膀胱切除术联合新辅助化疗的 3 年生存率最高，为 53%（95%CI 19-79）。
在美国，局部区域膀胱小细胞癌主要发生在白人男性中，他们在大都市、综合性社区癌症中心接受治疗。大多数患者接受了膀胱保留治疗，大多数患者接受了多模式治疗。接受新辅助化疗后行根治性膀胱切除术的患者生存情况最好。
