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Zhanghuang C, Zhang Z, Wang J, Yao Z, Ji F, Wu C, Ma J, Yang Z, Xie Y, Tang H, Yan B. Surveillance of prognostic risk factors in patients with SCCB using artificial intelligence: a retrospective study. Sci Rep 2023; 13:8727. [PMID: 37253772 DOI: 10.1038/s41598-023-35761-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/23/2023] [Indexed: 06/01/2023] Open
Abstract
Small cell carcinoma of the bladder (SCCB) is a rare urological tumor. The prognosis of SCCB is abysmal. Therefore, this study aimed to construct nomograms that predict overall survival (OS) and cancer-specific survival (CSS) in SCCB patients. Information on patients diagnosed with SCCB during 2004-2018 was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression models analyzed Independent risk factors affecting patients' OS and CSS. Nomograms predicting the OS and CSS were constructed based on the multivariate Cox regression model results. The calibration curve verified the accuracy and reliability of the nomograms, the concordance index (C-index), and the area under the curve (AUC). Decision curve analysis (DCA) assessed the potential clinical value. 975 patients were included in the training set (N = 687) and the validation set (N = 288). Multivariate COX regression models showed that age, marital status, AJCC stage, T stage, M stage, surgical approach, chemotherapy, tumor size, and lung metastasis were independent risk factors affecting the patients' OS. However, distant lymph node metastasis instead AJCC stage is the independent risk factor affecting the CSS in the patients. We successfully constructed nomograms that predict the OS and CSS for SCCB patients. The C index of the training set and the validation set of the OS were 0.747 (95% CI 0.725-0.769) and 0.765 (95% CI 0.736-0.794), respectively. The C index of the CSS were 0.749 (95% CI 0.710-0.773) and 0.786 (95% CI 0.755-0.817), respectively, indicating that the predictive models of the nomograms have excellent discriminative power. The calibration curve and the AUC also show good accuracy and discrimination of the nomograms. To sum up, We established nomograms to predict the OS and CSS of SCCB patients. The nomograms have undergone internal cross-validation and show good accuracy and reliability. The DCA shows that the nomograms have an excellent clinical value that can help doctors make clinical-assisted decision-making.
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Affiliation(s)
- Chenghao Zhanghuang
- Department of Urology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Yunnan Province Clinical Research Center for Children's Health and Disease, 288 Qianxing Road, Kunming, 650228, Yunnan, People's Republic of China
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
- Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Province Clinical Research Center for Children's Health and Disease, Yunnan Clinical Medical Center for Pediatric Disease, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, People's Republic of China
- Department of Oncology, Yunnan Children Solid Tumor Treatment Center, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, People's Republic of China
| | - Zhaoxia Zhang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jinkui Wang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhigang Yao
- Department of Urology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Yunnan Province Clinical Research Center for Children's Health and Disease, 288 Qianxing Road, Kunming, 650228, Yunnan, People's Republic of China
| | - Fengming Ji
- Department of Urology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Yunnan Province Clinical Research Center for Children's Health and Disease, 288 Qianxing Road, Kunming, 650228, Yunnan, People's Republic of China
| | - Chengchuang Wu
- Department of Urology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Yunnan Province Clinical Research Center for Children's Health and Disease, 288 Qianxing Road, Kunming, 650228, Yunnan, People's Republic of China
| | - Jing Ma
- Department of Otolaryngology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, People's Republic of China
| | - Zhen Yang
- Department of Oncology, Yunnan Children Solid Tumor Treatment Center, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, People's Republic of China
| | - Yucheng Xie
- Department of Pathology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, People's Republic of China
| | - Haoyu Tang
- Department of Urology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Yunnan Province Clinical Research Center for Children's Health and Disease, 288 Qianxing Road, Kunming, 650228, Yunnan, People's Republic of China
| | - Bing Yan
- Department of Urology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Yunnan Province Clinical Research Center for Children's Health and Disease, 288 Qianxing Road, Kunming, 650228, Yunnan, People's Republic of China.
- Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Province Clinical Research Center for Children's Health and Disease, Yunnan Clinical Medical Center for Pediatric Disease, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, People's Republic of China.
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Teo MY, Guercio B, Arora A, Hao X, Regazzi AM, Donahue T, Herr HW, Goh AC, Cha EK, Pietzak E, Donat SM, Dalbagni G, Bochner BH, Olgac S, Sarungbam J, Sirintrapun SJ, Chen YB, Gopalan A, Fine SW, Tickoo SK, Reuter VE, Weigelt B, Schultheis AM, Funt S, Bajorin DF, Iyer G, Ostrovnaya I, Rosenberg JE, Al-Ahmadie H, Al-Ahmadie H. Long-term Outcomes of Local and Metastatic Small Cell Carcinoma of the Urinary Bladder and Genomic Analysis of Patients Treated With Neoadjuvant Chemotherapy. Clin Genitourin Cancer 2022; 20:431-441. [PMID: 35676169 PMCID: PMC9809986 DOI: 10.1016/j.clgc.2022.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Small cell carcinoma of the bladder (SCCB) is a rare variant of bladder cancer with poor outcomes. We evaluated long-term outcomes of nonmetastatic (M0) and metastatic (M1) SCCB and correlated pathologic response with genomic alterations of patients treated with neoadjuvant chemotherapy (NAC). PATIENTS AND METHODS Clinical history and pathology samples from SCCB patients diagnosed at our institution were reviewed. RESULTS One hundred and ninety-nine SCCB patients were identified. (M0: 147 [74%]; M1: 52 [26%]). Among M0 patients, 108 underwent radical cystectomy (RC) (NAC: 71; RC only: 23; adjuvant chemotherapy: 14); 14 received chemoradiotherapy; the rest received chemotherapy alone or no cancer-directed therapy. RC-only patients had a median follow-up of 9.1 years, and median disease-free survival (DFS) and overall survival (OS) were 1.1 and 1.2 years, respectively. NAC patients had pathologic response (<pT2pN0) and pathologic complete response (pT0pN0) rates of 48% and 38%, respectively, with median follow-up of 7.2 years, and median DFS and OS of 5.6 and 14.5 years, respectively. NAC responders (<ypT2N0) had superior median DFS (14.5 vs. 0.6 years, hazard ratio [HR] 0.24, P< .001) and OS (14.5 vs. 2.5 years, HR 0.31, P = .002). DFS rates for responders and nonresponders were 76% and 27% at 5 years, and 71% and 23% at 10 years, respectively. Local and central nervous system recurrences were infrequent. Median progression-free survival (PFS) and OS for M1 disease were 6.9 and 10.3 months, respectively. Genomic profiling was performed on 47 NAC patients. Loss of ERCC2 function was significantly enriched among those with pathologic complete response to NAC (mutations present in 50% of pathologic complete responders vs. 15% nonresponders, P = .045). CONCLUSION M0 SCCB is chemo-sensitive and patients have excellent long-term survival following response to NAC. Patients with M1 disease have poor survival despite systemic therapy. Loss-of-function mutations of ERCC2 were associated with pathologic complete response to NAC.
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Affiliation(s)
- Min Yuen Teo
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brendan Guercio
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arshi Arora
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ashley M Regazzi
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy Donahue
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Harry W Herr
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Alvin C. Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Eugene K. Cha
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Eugene Pietzak
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Sherri M. Donat
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Guido Dalbagni
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Bernard H. Bochner
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Semra Olgac
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Judy Sarungbam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ying-Bei Chen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anuradha Gopalan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samson W. Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Satish K. Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victor E. Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anne M. Schultheis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Institute of Pathology, University Hospital Cologne and University of Cologne, Cologne, Germany
| | - Samuel Funt
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Dean F. Bajorin
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Gopa Iyer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Irina Ostrovnaya
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan E. Rosenberg
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Treatment Outcomes for Small Cell Carcinoma of the Bladder: Results From a UK Patient Retrospective Cohort Study. Int J Radiat Oncol Biol Phys 2021; 110:1143-1150. [PMID: 33561506 DOI: 10.1016/j.ijrobp.2021.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Small cell carcinoma of the bladder (SCCB) is rare, accounting for less than 1% of all bladder carcinomas. It is aggressive, and outcomes are poor as a result of its early metastatic spread. Owing to its rarity, there are limitations on data to propose standardized management pathways. METHODS AND MATERIALS We conducted a retrospective analysis of patients presenting with pure or predominant-histology SCCB to 26 institutions in the United Kingdom between 2006 and 2016. The data cutoff date was February 1, 2018. We report patient characteristics, treatment received, and subsequent clinical outcomes. RESULTS A total of 409 eligible patients were included. Among these, 306 (74.8%) were male, the median age was 71 years (range, 35-96 years), and 189 patients (46.2%) had pure-histology SCCB. At data cutoff, 301 patients (73.6%) had died. The median overall survival (OS) was 15.9 months (95% CI, 13.2-18.7 months). Two hundred patients (48.9%) were confirmed to have bladder-confined disease (N0, M0), with a median OS of 28.3 months (95% CI, 20.9-35.8 months), versus a median OS of 12.7 months (95% CI, 10.9-14.6 months) for the 172 patients (42.1%) with confirmed N1-3 and/or M1 disease (hazard ratio [HR], 2.03; 95% CI, 1.58-2.60; P < .001). A total of 247 patients (61.5%) received primary chemotherapy, with a median OS of 21.6 months (95% CI, 15.5-27.6 months), versus a median OS of 9.1 months (95% CI, 5.4-12.8 months) in patients who did not receive primary chemotherapy (HR, 0.46; 95% CI, 0.37-0.59; P < .001). Choice of chemotherapy agent did not alter outcomes. For those with bladder-confined disease, 61 (30.5%) underwent cystectomy, and 104 (52.0%) received radiation therapy. Survival outcomes were similar for both cystectomy and radiation therapy. Only 6 patients (1.5%) were identified as having brain metastases at any time point. CONCLUSIONS To our knowledge, this is the largest retrospective study of all-stage SCCB to date. Patients have a poor prognosis overall, but survival is improved in those able to receive chemotherapy and with organ-confined disease. Brain metastases are rare.
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Nagumo Y, Kawai K, Kojima T, Shiga M, Kojo K, Tanaka K, Kandori S, Kimura T, Kawahara T, Okuyama A, Higashi T, Nishiyama H. Prognostic significance of non-urothelial carcinoma of bladder: analysis of nationwide hospital-based cancer registry data in Japan. Jpn J Clin Oncol 2020; 50:1068-1075. [PMID: 32469066 DOI: 10.1093/jjco/hyaa072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 05/05/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To identify the prognosis of pure non-urothelial carcinoma (non-UC) of bladder and to compare them with those of pure urothelial carcinoma (UC). METHODS We used Japan's nationwide hospital-based cancer registry data to extract histologically confirmed pure non-UC and UC cases of bladder diagnosed in 2008-2009. We estimated the 5-year overall survival (OS) by a Kaplan-Meier analysis. RESULTS A total of 8094 patients with confirmed histological subtypes of bladder cancer were identified. The most common pure non-UC was squamous cell carcinoma (SQ, n = 192, 2.4%) followed by adenocarcinoma (AC, n = 138, 1.7%) and small cell neuroendocrine carcinoma (SmC, n = 54, 0.7%). The proportion of female patients (48%) was significantly higher in the SQ group compared with the pure UC group (P < 0.001). The 5-year OS rate of the non-UC patients was significantly worse than that of the UC patients (40 vs. 61%, P < 0.001). According to stages, the 5-year OS rates of the stage I and III non-UC patients were significantly worse than those of the UC patients (P = 0.001). Considering histologic subtypes and stages, the 5-year OS rates of the stage I SQ patients were worse than those of the AC and SmC patients (46, 68 and 64%, respectively). CONCLUSION The prognosis of pure non-UC was worse than that of pure UC, especially in the stage I and III non-UC patients. To improve these patients' oncologic outcomes, a more aggressive surgical approach may be necessary in stage I patients with non-UC, especially in pure SQ.
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Affiliation(s)
- Yoshiyuki Nagumo
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Koji Kawai
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takahiro Kojima
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masanobu Shiga
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kosuke Kojo
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ken Tanaka
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shuya Kandori
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomokazu Kimura
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takashi Kawahara
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ayako Okuyama
- Center for Cancer Registries, Center for Cancer Control and Information Service, National Cancer Center, Tokyo, Japan
| | - Takahiro Higashi
- Center for Cancer Registries, Center for Cancer Control and Information Service, National Cancer Center, Tokyo, Japan
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