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Updated: Jun 11, 2025
An Orthotopic Bladder Tumor Model and the Evaluation of Intravesical saRNA Treatment
Published on: July 28, 2012
A Single Institution Experience in the Management of Localized Neuroendocrine Carcinoma of the Bladder
Casey Liveringhouse1, Austin J Sim2, Jingsong Zhang3
1Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
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.
Insights
Neoadjuvant chemotherapy (NAC) followed by local consolidation improves outcomes for neuroendocrine carcinoma of the bladder (NEC-bladder). Achieving a ypN0 status after NAC is crucial for long-term survival in NEC-bladder patients.
Area of Science:
- Oncology
- Urologic Oncology
- Cancer Research
Background:
- Neuroendocrine carcinoma of the bladder (NEC-bladder) is a rare malignancy with limited treatment options and poor prognosis.
- Current therapeutic strategies for NEC-bladder are variable and require optimization.
Purpose of the Study:
- To evaluate the efficacy of neoadjuvant chemotherapy (NAC) followed by local consolidation in patients with localized NEC-bladder.
- To identify prognostic factors influencing progression-free survival (PFS) and overall survival (OS) in NEC-bladder.
Main Methods:
- Retrospective analysis of localized NEC-bladder patients treated with surgery or chemoradiation between 2001-2021.
- Evaluation of pathologic complete response (pCR) and downstaging rates post-NAC in surgically treated patients.
- Univariable and multivariable analyses (Cox regression) to assess PFS and OS.
Main Results:
- Neoadjuvant chemotherapy (NAC) significantly improved PFS (p=0.04).
- Downstaging after NAC was associated with improved PFS (p=0.012) and OS (p<0.001).
- Achieving ypN0 status post-NAC correlated with a median OS of 69.9 months, versus 15.3 months for ypN+ (p<0.001).
Conclusions:
- Optimized treatment for NEC-bladder involves NAC followed by local consolidation therapy.
- Pathologic nodal status (ypN0) after NAC is a critical predictor of long-term survival in NEC-bladder patients.
