Mackey J R, Au H J, Hugh J, Venner P
Cross Cancer Institute and Department of Oncology, University of Alberta, Edmonton, Canada.
J Urol. 1998 May;159(5):1624-9. doi: 10.1097/00005392-199805000-00058.
We assessed the prognostic impact of genitourinary small cell carcinoma tumor and patient characteristics, and therapy.
We retrospectively reviewed the records of 180 patients with genitourinary small cell carcinoma in which patient and tumor characteristics, therapy, followup duration and survival status had been documented. Patient age, sex, primary site, histological features, tumor size, stage, locoregional therapy, systemic chemotherapy and hormonal manipulations were analyzed for association with survival.
There were 106 cases of bladder, 60 prostatic, 8 renal and 6 ureteral small cell carcinoma. Median survival was 10.5 months overall, and 7 and 13 months for prostatic and bladder small cell carcinoma, respectively (p <0.0001 log rank analysis). In all cases metastatic disease at presentation (p <0.008, risk ratio 1.9) predicted poor survival on multivariate analysis. Radical surgery (p <0.0001, risk ratio 0.34) and cisplatin chemotherapy (p <0.0001, risk ratio 0.20) were the only factors that predicted improved survival on multivariate analysis. For prostatic small cell carcinoma primary surgical therapy (p <0.012, risk ratio 0.46) was the only parameter that predicted survival on univariate analysis. For bladder small cell carcinoma only cisplatin chemotherapy (p <0.0001, risk ratio 0.15) predicted survival on multivariate analysis.
Genitourinary small cell carcinoma has a poor prognosis, which is worse in prostatic than bladder disease. Patient and tumor characteristics were not determinants of survival when prostatic and bladder small cell carcinoma were analyzed individually. For prostatic disease only primary surgical therapy was associated with prolonged survival, while for bladder disease cisplatin chemotherapy was associated with a favorable prognosis. We recommend considering primary surgical therapy for prostatic and cisplatin based chemotherapy for bladder small cell carcinoma.
我们评估了泌尿生殖系统小细胞癌的肿瘤及患者特征和治疗对预后的影响。
我们回顾性分析了180例泌尿生殖系统小细胞癌患者的记录，这些记录中包含患者和肿瘤特征、治疗、随访时间及生存状态。分析患者年龄、性别、原发部位、组织学特征、肿瘤大小、分期、局部区域治疗、全身化疗及激素治疗与生存的相关性。
其中有106例膀胱小细胞癌、60例前列腺小细胞癌、8例肾小细胞癌和6例输尿管小细胞癌。总体中位生存期为10.5个月，前列腺和膀胱小细胞癌的中位生存期分别为7个月和13个月（对数秩分析，p<0.0001）。在所有病例中，就诊时存在转移性疾病（p<0.008，风险比1.9）在多因素分析中预示着生存不良。根治性手术（p<0.0001，风险比0.34）和顺铂化疗（p<0.0001，风险比0.20）是多因素分析中仅有的预示生存改善的因素。对于前列腺小细胞癌，原发性手术治疗（p<0.012，风险比0.46）是单因素分析中唯一预示生存的参数。对于膀胱小细胞癌，多因素分析中仅顺铂化疗（p<0.0001，风险比0.15）预示生存。
泌尿生殖系统小细胞癌预后较差，前列腺疾病的预后比膀胱疾病更差。单独分析前列腺和膀胱小细胞癌时，患者和肿瘤特征并非生存的决定因素。对于前列腺疾病，仅原发性手术治疗与生存期延长相关，而对于膀胱疾病，顺铂化疗与良好预后相关。我们建议考虑对前列腺小细胞癌进行原发性手术治疗，对膀胱小细胞癌进行基于顺铂的化疗。
