A Single Institution Experience in the Management of Localized Neuroendocrine Carcinoma of the Bladder

IF 2.3 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer Pub Date : 2024-09-07 DOI:10.1016/j.clgc.2024.102222

Casey Liveringhouse , Austin J. Sim , Jingsong Zhang , Rohit K. Jain , Shreyas U. Naidu , Lauren Linkowski , Logan W. Zemp , Alice Yu , Wade J. Sexton , Philippe E. Spiess , Scott M. Gilbert , Michael A. Poch , Julio Pow-Sang , Roger Li , Brandon J. Manley , Aram Vosoughi , Jasreman Dhillon , Hongzhi Xu , Javier F. Torres-Roca , Peter A.S. Johnstone , G. Daniel Grass

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引用次数: 0

Abstract

Background

Neuroendocrine carcinoma of the bladder (NEC-bladder) is a rare disease with poor outcomes and variable treatment approaches.

Materials and Methods

Patients with localized NEC-bladder treated with surgery or radiation between 2001-2021 were retrospectively identified. Rates of pathologic complete response (pCR) and downstaging were evaluated following NAC in surgically-treated patients. Progression-free survival (PFS) and overall survival (OS) were analyzed with univariable (log-rank) and multivariable (MVA; Cox regression) methods.

Results

Sixty-five patients were identified having a median age of 73. The tumor histology distribution was small cell (64.6%) or urothelial with NE differentiation (35.4%). Most patients (69.2%) received NAC. Patients received local therapy by surgery (78.5%) or chemoradiation (21.5%). The majority (62.7%) of surgical patients had ≥ pT2 with 37.3% having nodal involvement (pN+). The pCR and downstaging rates were 21.6% and 35.1%, respectively. At a median follow-up of 60 months (m), the median PFS and OS were 16.4m and 25.9m, respectively. NAC improved PFS (p=0.04) and downstaging improved PFS (p=0.012) and OS (p<0.001). Patients receiving NAC with ypN0 vs. ypN+ had median OS of 69.9m vs 15.3m, respectively (p<0.001). MVA identified receipt of NAC and pN as predictors of PFS; pN was predictive of OS. No differences in PFS or OS were seen between histology of primary tumor. The brain metastasis rate was 10.8% with all patients having small cell histology.

Conclusions

Optimized therapy in NEC-bladder includes NAC followed by local consolidation. Ascertainment of ypN0 is associated with long term survival, while pN+ remains associated with poor outcomes.

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单个机构治疗膀胱局部神经内分泌癌的经验

背景膀胱神经内分泌癌（NEC-膀胱）是一种罕见的疾病，治疗效果不佳，治疗方法也不尽相同。评估了手术治疗患者NAC后的病理完全反应（pCR）率和降期率。采用单变量（log-rank）和多变量（MVA；Cox回归）方法分析了无进展生存期（PFS）和总生存期（OS）。肿瘤组织学分布为小细胞（64.6%）或伴有NE分化的尿路上皮（35.4%）。大多数患者（69.2%）接受了 NAC 治疗。患者通过手术（78.5%）或化疗（21.5%）接受局部治疗。大多数手术患者（62.7%）≥ pT2，37.3%有结节受累（pN+）。pCR和降期率分别为21.6%和35.1%。中位随访时间为60个月（m），中位PFS和OS分别为16.4m和25.9m。NAC改善了PFS（p=0.04），而降期治疗改善了PFS（p=0.012）和OS（p<0.001）。ypN0与ypN+患者接受NAC治疗的中位OS分别为69.9m与15.3m（p<0.001）。MVA 确定接受 NAC 和 pN 可预测 PFS；pN 可预测 OS。不同原发肿瘤组织学之间的 PFS 或 OS 无差异。脑转移率为10.8%，所有患者均为小细胞组织学。确定ypN0与长期生存有关，而pN+仍与不良预后有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical genitourinary cancer 医学-泌尿学与肾脏学

CiteScore

5.20

自引率

6.20%

发文量

201

审稿时长

54 days

期刊介绍： Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.