Abstract
BACKGROUND: This study aimed to identify prognostic factors influencing survival in patients with bladder neuroendocrine carcinoma (NC). METHODS: This study utilized the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015) to compare NC with urothelial carcinoma (UC). We evaluated the prognostic value of clinicopathological characteristics and survival outcomes for bladder NC patients. Multivariable Cox proportional hazard models and propensity score matching (PSM) were employed for analysis. RESULT: A total of 99,704 patients were included, with 603 in the NC group and 99,101 in the UC group. Compared with the UC group, the NC group was inclined to receive radical cystectomy (34.2% vs. 12.2%), radiation (25.0% vs. 4.6%) and chemotherapy (62.0% vs. 22.2%) as treatment options. Multivariate Cox regression analysis revealed higher overall survival (OS) and cancer-specific survival (CSS) outcomes for NC patients who underwent radical cystectomy (HR = 0.569, 95% CI = 0.537-0.603, p < 0.001; HR = 0.531, 95% CI = 0.489-0.577, p < 0.001; respectively). To mitigate bias, a 1:1 propensity score-matched analysis was performed on both groups, resulting in 1202 patients (n = 601 per group). Multivariate Cox regression analysis identified seven risk factors for OS and CSS: age at diagnosis, race, cT stage, cN stage, cM stage, histological type, and chemotherapy. Additionally, surgery of the primary site was a prognostic factor for OS. A better prognosis was observed for NC patients who underwent radical cystectomy compared to those who did not. NC patients who only received radical cystectomy have a better prognosis in both OS (log-rank p = 0.002) and CSS (log-rank p = 0.009) compared with those who only received radiotherapy. CONCLUSION: Age, race, TNM stage, chemotherapy, and surgery were identified as independent predictors of bladder NC patients. Radical cystectomy may represent the optimal therapeutic approach to improve the prognosis of NC patients.