GENITOURINARY SMALL-CELL CARCINOMA - DETERMINATION OF CLINICAL AND THERAPEUTIC FACTORS ASSOCIATED WITH SURVIVAL

Purpose: We assessed the prognostic impact of genitourinary small cell carcinoma tumor and patient characteristics, and therapy. Materials a nd Methods: We retrospectively reviewed the records of 180 patients wi th genitourinary small cell carcinoma in which patient and tumor chara cteristics, therapy, followup duration and survival status had been do cumented. Patient age, sex, primary site, histological features, tumor size, stage, locoregional therapy, systemic chemotherapy and hormonal manipulations were analyzed for association with survival. Results: T here were 106 cases of bladder, 60 prostatic, 8 renal and 6 ureteral s mall cell carcinoma. Median survival was 10.5 months overall, and 7 an d 13 months for prostatic and bladder small cell carcinoma, respective ly (p < 0.0001 log rank analysis). In all cases metastatic disease at presentation (p < 0.008, risk ratio 1.9) predicted poor survival on mu ltivariate analysis. Radical surgery (p < 0.0001, risk ratio 0.34) and cisplatin chemotherapy (p < 0.0001, risk ratio 0.20) were the only fa ctors that predicted improved survival on multivariate analysis. For p rostatic small cell carcinoma primary surgical therapy (p < 0.012, ris k ratio 0.46) was the only parameter that predicted survival on univar iate analysis, For bladder small cell carcinoma only cisplatin chemoth erapy (p < 0.0001, risk ratio 0.15) predicted survival on multivariate analysis. Conclusions: Genitourinary small cell carcinoma has a poor prognosis, which is worse in prostatic than bladder disease. Patient a nd tumor characteristics were not determinants of survival when prosta tic and bladder small cell carcinoma were analyzed individually. For p rostatic disease only primary surgical therapy was associated with pro longed survival, while for bladder disease cisplatin chemotherapy was associated with a favorable prognosis. We recommend considering primar y surgical therapy for prostatic and cisplatin based chemotherapy for bladder small cell carcinoma.