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

Autor: Liveringhouse C; Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Sim AJ; Deparment of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH., Zhang J; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Jain RK; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Naidu SU; College of Arts and Sciences, University of South Florida, Tampa, FL., Linkowski L; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA., Zemp LW; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Yu A; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Sexton WJ; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Spiess PE; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Gilbert SM; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Poch MA; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Pow-Sang J; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Li R; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Manley BJ; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Vosoughi A; Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa FL., Dhillon J; Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa FL., Xu H; Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa FL., Torres-Roca JF; Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Johnstone PAS; Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Yamoah K; Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Grass GD; Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL. Electronic address: Daniel.Grass@moffitt.org.
Jazyk: angličtina
Zdroj: Clinical genitourinary cancer [Clin Genitourin Cancer] 2024 Dec; Vol. 22 (6), pp. 102222. Date of Electronic Publication: 2024 Sep 07.
DOI: 10.1016/j.clgc.2024.102222
Abstrakt: 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.
Competing Interests: Disclosure Austin Sim: leadership role (ASTRO non-voting member board of directors). Jingsong Zhang: honoraria (Seagen); participation on Data Safety Monitoring Board (Seagen). Philippe E. Spiess: NCCN panel member for bladder and penile cancer. Roger Li: research support (predicine; veracyte; CG oncology; Valar Labs; Merck); clinical trial protocol committee (CG oncology; Merck; Janssen); Scientific advisor/consultant (Bristol Myers Squibb; Merck, Fergene, Arquer Diagnostics, Urogen Pharma, Lucence, CG Oncology, Janssen, Thericon); Honoraria (SAI MedPartners, Solstice Health Communications, Putnam Associates, UroToday). Javier F. Torres-Roca: intellectual property (RSI) and stock in Cvergenx . G. Daniel Grass: research support (ArteraAI). All other authors state that they have no conflicts of interest.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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