Representing the 0,7% of all bladder cancers, the small cell carcinomas (SCBC) are characterized by their aggressiveness, rapid progression and early metastasis. Therapeutic outcomes have not improved over the last 20 years and, due to lack of prospective studies, standard treatments for localized or metastatic disease are not yet well established.
Pooled analysis of 281 patients with pure or mixed SCBC from 28 spanish centers, treated between 1992 and 2015, has been performed. Endpoints of this study were: disease clinical and pathological characteristics, treatments performed and differences in OS. Differences among treatment options for localized SCBC are reported: radical cistectomy (RC), neoadjuvant (NeoQT) and adjuvant chemotherapy (AdjQT) (carboplatin-etoposide (CA-VP16) or cisplatin-etoposide (C-VP16).
With a median follow up of 108 months, 281 SCBC patients are included. Median age at diagnosis was 71,9 years, 86,1% were male and 77,4% smokers. Histology was predominantly SCBC in 100% of the cases, 60(50,4%) were pure microcytic histology, 33(27,7%) had transitional component and 36(30,2%) had sarcomatoid, micropapillary or other lineage. RC was performed in 119 patients (49,2%). Nine (7%) tumors were pT0, 11(8,6%) were non muscle invasive, 83(64,8%) invaded muscular and 25(19,5%) were pT4. Twenty four (11, 8%) patients received NeoQT (41,8% C-VP16 and 44,3% CA-VP16); AdjQT was given in 47(23,2%) cases, (31,3% C-VP16 and 45,8% CA-VP16). Median OS among treatments were: 98,3 months for RC, 73,2 months for NeoQT (C-VP16 43,9m; CA-VP16: 30,8m) and 100,4 months for AdjQT (C-VP16: 137,4 m; CA-VP16: 45,4m), the differences found not to be statistically significant (p = 0,75).
We present the largest published series on SCBC. Outcome data from 281 SCBC cases has not shown statistically significant differences in OS among patients who have undergone RC alone compared to those receiving NeoQT or AdjQT (p = 0,75). Furthermore, no significant differences among the different QT schemes were observed.
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All authors have declared no conflicts of interest.