Mose Lucas, Maitre Priyamvada, Eberz Pascal, Zilli Thomas, Mohamad Osama, Murthy Vedang, Fankhauser Christian D, Kiss Bernhard, Roth Beat, Aebersold Daniel M, Vogl Ursula, Shelan Mohamed
Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Department of Radiation Oncology, ACTREC, Tata Memorial Centre, and Homi Bhabha National Institute (HBNI), Mumbai, India.
Clin Transl Radiat Oncol. 2025 Aug 13;55:101032. doi: 10.1016/j.ctro.2025.101032. eCollection 2025 Nov.
Small cell bladder cancer is an aggressive histological subtype and represents one of the most common extra-pulmonary small cell carcinomas. Treatment options include radical cystectomy, chemotherapy, radiotherapy, or combinations of these three. However, the optimal treatment approach remains unknown. This -analysis assesses the current literature on non-metastatic SCBC and analyzes different treatment approaches.
A comprehensive search was conducted in four electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) utilizing the search terms "small or neuroendocrine AND cancer OR Carcinoma OR Tumor OR Malignan* OR oncolog* OR metastati* OR neoplasm AND bladder or urothelial or Urologic" from inception until March 2024. Eligible papers reported treatment and overall survival (OS) of non-metastatic SCBC patients. A -analysis was conducted comparing treatments with radical cystectomy- and radiotherapy-based approaches in addition to the use of chemotherapy.
In total, 12 articles were included in the present systematic review and -analysis. Regarding the comparison between radical cystectomy-based treatment and radiotherapy-based treatment, comparable OS was observed between both groups as the reported hazard ratio (HR) was found to be 1.04 (95 % confidence intervals [CI]: 0.90, 1.20, p = 0.6). After including chemotherapy in the analysis, it was observed that using radical cystectomy or radiotherapy with the addition of chemotherapy showed better OS with lower HR (0.53 [95 %CI: 0.39, 0.73], p < 0.0001) compared with radical cystectomy or radiotherapy without chemotherapy. The median OS of radical cystectomy or radiotherapy with chemotherapy was higher than that of radical cystectomy or radiotherapy without chemotherapy, and chemotherapy alone as follows: 30.89 (95 %CI: 23.82, 40.08), 19.67 (95 %CI: 16.26, 23.80), and 19.20 (95 %CI: 16.55, 22.28), respectively.
In this systematic review and -analysis, no OS difference was observed in patients undergoing radical cystectomy-based or radiotherapy-based treatments. The addition of chemotherapy to local therapy seems to improve OS. However, given the high heterogeneity of the included studies, these results should be interpreted cautiously.
小细胞膀胱癌是一种侵袭性组织学亚型，是最常见的肺外小细胞癌之一。治疗选择包括根治性膀胱切除术、化疗、放疗或这三种方法的联合应用。然而，最佳治疗方法仍不明确。本分析评估了关于非转移性小细胞膀胱癌的现有文献，并分析了不同的治疗方法。
利用检索词“small或neuroendocrine AND cancer或Carcinoma或Tumor或Malignan或oncolog或metastati*或neoplasm AND bladder或urothelial或Urologic”，在四个电子数据库（PubMed、Scopus、Web of Science和Cochrane图书馆）中进行全面检索，检索时间从建库至2024年3月。符合条件的论文报告了非转移性小细胞膀胱癌患者的治疗情况和总生存期（OS）。除了使用化疗外，还对基于根治性膀胱切除术和放疗的治疗方法进行了比较分析。
本系统评价和分析共纳入12篇文章。关于基于根治性膀胱切除术的治疗与基于放疗的治疗之间的比较，两组观察到的总生存期相当，因为报告的风险比（HR）为1.04（95%置信区间[CI]：0.90，1.20，p = 0.6）。在分析中纳入化疗后，观察到与未使用化疗的根治性膀胱切除术或放疗相比，在根治性膀胱切除术或放疗基础上加用化疗显示出更好的总生存期，风险比更低（0.53[95%CI：0.39，0.73]，p < 0.0001）。接受化疗的根治性膀胱切除术或放疗的中位总生存期高于未接受化疗的根治性膀胱切除术或放疗，单独化疗的情况如下：分别为30.89（95%CI：23.82，40.08）、19.67（95%CI：16.26，23.80）和19.20（95%CI：16.55，22.28）。
在本系统评价和分析中，接受基于根治性膀胱切除术或放疗的治疗的患者未观察到总生存期差异。在局部治疗中加入化疗似乎能改善总生存期。然而，鉴于纳入研究的高度异质性，这些结果应谨慎解读。
