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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2023.1076    [Accepted]
Clinical Outcomes of Small Cell Carcinoma of the Genitourinary Tract and the Prognostic Significance of the Tumor Immune Microenvironment
Jaewon Hyung1 , Hyung-Don Kim1 , Gi Hwan Kim2, Yong Mee Cho2, Yeon-Mi Ryu3, Sang-Yeob Kim3, Inkeun Park1, Shinkyo Yoon1 , Jae Lyun Lee1
1Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea
Correspondence  Shinkyo Yoon ,Tel: 82-2-3010-3203, Fax: 82-2-3010-6961, Email: shinkyoyoon@amc.seoul.kr
Jae Lyun Lee ,Tel: 82-2-3010-5977, Fax: 82-2-3010-6961, Email: jaelyun@amc.seoul.kr
Received: September 26, 2023;  Accepted: November 28, 2023.  Published online: November 29, 2023.
*Jaewon Hyung and Hyung-Don Kim contributed equally to this work.
ABSTRACT
Purpose
Small cell carcinoma of the genitourinary tract (GU SCC) is a rare disease with a poor prognosis. There are only limited treatment options due to insufficient understanding of the disease. In this study, we analyzed the clinical outcomes of patients with GU SCC and their association with the tumor immune phenotype.
Materials and Methods
Patients diagnosed with GU SCC were included. Survival outcomes according to the primary location (prostate and non-prostate) and stages (limited disease [LD] and extensive disease [ED]) were analyzed. We performed multiplex immunohistochemistry (IHC) in non-prostate SCC patients and analyzed the immune cell population.
Results
A total of 77 patients were included in this study. Their median age was 71 years, 67 patients (87.0%) were male, and 48 patients (62.3%) had non-prostate SCC. All patients with ED (n=31, 40.3%) received etoposide plus platinum (EP) as initial treatment and median overall survival (OS) was 9.7 months (95% CI 7.1-18.6 months). Patients with LD (n=46, 59.7%) received EP followed by radiotherapy or surgery, and 24-months OS rate was 63.6% (95% CI 49.9-81.0). The multiplex IHC analysis of 21 patients with non-prostate SCC showed that patients with a higher density of PD-L1-expressing CD68+CD206+ M2-like macrophages had significantly worse OS outcomes with an adjusted hazards ratio of 4.17 (95% CI 1.25-14.29, adjusted p=0.02).
Conclusion
Patients with GU SCC had a poor prognosis, even those with localized disease. The tumor immune phenotypes were significantly associated with survival. This finding provides new insights for treating GU SCC.
Key words: Small cell carcinoma, Neuroendocrine carcinoma, Genitourinary tract, Multiplex immunohistochemistry
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