Analysis of clinical features and management methods of neuroendocrine carcinoma in urology / 中华泌尿外科杂志

ABSTRACT

Objective:To study the clinical features, management methods, and survival of patients with urinary neuroendocrine carcinoma (NEC).Methods:A retrospective study of 22 patients with urinary NEC was performed from March 2008 to August 2019, including 21 male and 1 female. The average age was 68.2±9.9 years. Location of the lesion included left adrenal gland 1 case, right kidney 1 case, left ureter 1 case, bladder 9 cases and prostate 10 cases. 16 cases with bladder or prostate NECs had hematuria. Radiological feature was solid tumors with inhomogeneous enhancement and obvious local invasion. Clinical TNM stages included left adrenal NEC(T 2N 0M 0), right kidney(T 4N 1M 0), left ureter(T 3N 1M 0), bladder(2 cases with T 2N 0M 0, 2 with T 3N 0M 0, 3 with T 3N 1M 0, 1 with T 4N 2M 0 and 1 with T 4N 1M 1), prostate(2 cases with T 2N 0M 0, 2 with T 3N 0M 0, 1 with T 4N 0M 0, 2 with T 4N 0M 1 and 3 with T 4N 1M 1). Radical surgery was performed for 8 patients (5 with bladder NECs, 1 for renal, ureter and prostate NECs respectively). Tumor resection was performed for left adrenal NEC. 4 bladder NECs and 3 prostate NECs were managed with palliative resections and 4 prostate NECs with conservative treatment, 2 prostate NECs lost to follow up after needle biopsy. Results:Pathological results were as follows, 12 cases with primary SCNECs, 2 cases with NECs, 3 cases were bladder SCNECs combined with high grade urothelial carcinoma, 4 cases were prostate SCNECs combined with adenocarcinoma, 1 case was SCNEC combined with LCNEC. Pathological tests indicated that average Ki-67 was (60.9±16.0)%, synaptophysin(SYN)was positive in 20 cases, chromogranin A(CgA)in 10 cases and CD56 in 19 cases. The median following time was 15.5 months(8-108 months)of 20 patients, 16 were deceased, 3 were surviving with tumor and 1 with clinical cure. The 1-, 2- and 3-year overall survival rates between bladder NECs(66.7%, 22.2%, 11.1%)and NECs in other locations(90.9%, 63.6%, 42.4%) had statistical significance( P=0.038). Conclusions:Hematuria was the main symptom of bladder and prostate NEC. SCNEC is the most common pathological type, many were in advanced stage when diagnosed. Even though managed with radical surgery, most of cases had poor prognosis, overall survival rate of bladder NECs was lower than other locations. Radical surgery in early stage and multi-disciplinary therapy can improve the situation.