Definitive Chemoradiotherapy Versus Radical Cystectomy for Small Cell Carcinoma of the Bladder: A Multicenter Retrospective Study
In brief
Chemoradiation achieves 83% five-year survival, matching surgery at 54%
In a retrospective review of 72 patients with non-metastatic small cell bladder cancer, definitive chemoradiotherapy produced a five-year overall survival of 82.6% versus 53.6% after radical cystectomy, with no statistically significant difference after adjusting for baseline factors. Nodal involvement predicted worse outcomes, and distant metastases remained the main failure mode, suggesting systemic chemotherapy remains essential while bladder-preserving chemoradiation may be an option for selected patients.
- Journal
- Clinical genitourinary cancer (Q1)
- Published
- 6 August 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Hyun Ju Kim, Won Park, Young Seok Kim, Jae-Sung Kim, Youngkyong Kim, Tae Gyu Kim, et al.
- PMID
- 42685655
- DOI
- 10.1016/j.clgc.2026.102642
Why clinicians should know about it
- Picked for Urology (paper of the day, 8 September 2026): Definitive CCRT vs cystectomy for small‑cell bladder carcinoma
Abstract
INTRODUCTION: To compare oncologic outcomes between radical cystectomy and definitive chemoradiotherapy in patients with nonmetastatic small cell carcinoma of the bladder (SCCB). MATERIALS AND METHODS: We retrospectively reviewed 72 patients with nonmetastatic SCCB treated with curative intent between 2005 and 2021 across 9 tertiary academic institutions. Patients were categorized into a radical cystectomy group (OP, n = 49) or a radiotherapy group (RT, n = 23). Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared using log-rank tests. To account for baseline imbalances, an IPTW analysis based on propensity scores was performed. RESULTS: The median follow-up duration was 31.3 months. Median OS was 66.2 months in the OP group and 71.6 months in the RT group (P = .305). The 5-year OS rates were 53.6% and 82.6% in the OP and RT groups, respectively. Stage-stratified and IPTW-adjusted analysis likewise showed no significant differences in OS between groups. On multivariable analysis, nodal involvement was independently associated with worse OS (HR, 9.877; 95% CI, 1.07-91.60; P = .044). Upfront chemotherapy showed a trend toward improved OS, although statistical significance was not reached (HR, 0.14; 95% CI, 0.01-2.25; P = .167). Distant metastasis was the predominant failure pattern in both groups. CONCLUSION: Definitive CCRT showed survival outcomes not significantly different from radical cystectomy, though baseline imbalances and small sample size warrant cautious interpretation. Given the predominance of distant failure, systemic chemotherapy remains a key component of treatment, and bladder-preserving CCRT may represent a treatment option for carefully selected patients.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.