BACKGROUND: The objective of this study was to test the effect of chemotherapy and/or radical cystectomy (RC) and/or radiotherapy (RT) on survival of patients with non-metastatic small-cell carcinoma of the urinary bladder (SCCUB). MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results registry (2001-2016), we identified patients with non-metastatic (T1-4, N0, M0) SCCUB. Treatment was defined as: chemotherapy alone, chemotherapy + RC, and chemotherapy + RT. Temporal trends, cumulative incidence plots, and multivariable competing risks regression models were used. RESULTS: Of 595 patients with SCCUB, 230 (38.5%), 159 (27%), and 206 (34.5%) were treated with chemotherapy alone, chemotherapy + RC, and chemotherapy + RT, respectively. The rates of chemotherapy + RC increased (estimated annual percentage changes [EAPC], +5.9%; P = .002). Conversely, chemotherapy alone (EAPC, -1.7%; P = .1) and chemotherapy + RT rates decreased (EAPC: -2.2%; P = .08). Overall, 5-year cancer-specific mortality (CSM) rates were 44%, 29%, and 40% for patients treated with chemotherapy alone, chemotherapy + RC, and chemotherapy + RT, respectively (P = .004). Relative to chemotherapy alone, patients treated with chemotherapy + RC experienced lower CSM (hazard ratio, 0.5; P < .001). Conversely, patients treated with chemotherapy + RT did not exhibit any CSM benefit (hazard ratio, 0.8; P = .2), when compared with chemotherapy alone. CONCLUSION: In contemporary patients with SCCUB with non-metastatic disease, the rates of chemotherapy + RC are increasing. Conversely, the rates of combined chemotherapy with RT and chemotherapy alone are decreasing. These patterns of treatment are in agreement with better cancer control in patients with SCCUB. In consequence, until more robust data become available, the combination of chemotherapy and RC should represent the recommended treatment strategy.

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Quebec Canada

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Quebec Canada; Academic Department of Urology IRCCS Policlinico San Donato University of Milan Milan Italy

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Quebec Canada; Department of Urology and Division of Experimental Oncology URI Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Quebec Canada; Department of Urology European Institute of Oncology IRCCS Milan Italy

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Quebec Canada; Department of Urology San Luigi Gonzaga Hospital University of Turin Turin Italy

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Quebec Canada; Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf Hamburg Germany

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Quebec Canada; Urology Unit ASST Spedali Civili of Brescia Department of Medical and Surgical Specialties Radiological Science and Public Health University of Brescia Brescia Italy

Department of Urology and Division of Experimental Oncology URI Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria; Department of Urology Weill Cornell Medical College New York NY; Department of Urology University of Texas Southwestern Dallas TX; Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic; Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Department of Urology European Institute of Oncology IRCCS Milan Italy

Department of Urology European Institute of Oncology IRCCS Milan Italy; Department of Oncology and Hemato Oncology University of Milan Milan Italy

Department of Urology IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico University of Milan Milan Italy

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