[Neuroendocrine small-cell bladder cancer: our experience]

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Neuroendocrine bladder cancer, particularly small-cell carcinoma, is exceptionally rare, accounting for <1% of bladder tumors.
• This variant exhibits aggressive behavior, a poor prognosis, with a 5-year survival rate below 8%.
• Patients often present with advanced disease (stage >T2) and metastatic spread (56%), with rapid progression common.

Observation:

• This study presents three cases of pure neuroendocrine small-cell bladder cancer.
• Hematuria was the primary symptom; all cases had locally advanced disease (>T2), with one metastatic and two with lymph node involvement and bilateral ureteral obstruction.
• Treatment involved radical cystectomy with pelvic lymph node dissection and urinary diversion in two patients, with platinum-based adjuvant chemotherapy administered to only two.

Findings:

• Two patients experienced cancer recurrence within two months post-surgery.
• All three patients succumbed to metastatic disease at 5, 7, and 13 months, with a median overall survival of 7 months.
• Peritoneal and intestinal relapse was common, with fatal gastrointestinal hemorrhage as the cause of death.

Implications:

• Optimal treatment for small-cell bladder cancer remains undetermined due to its rarity and lack of prospective studies.
• Neoadjuvant chemotherapy with platinum-based regimens, coupled with aggressive surgical intervention, is recommended.
• Combination therapy involving chemotherapy and radiotherapy should be considered for improved outcomes.