Clinicopathologic characteristics, therapy and outcomes of patients with primary ureteral small cell carcinoma: a case series and systematic review of the literature

Figures & data

Figure 1 Histochemical and immunohistochemical examinations of the tumors from our cases.

Notes: (A) SCC showed small and ovoid cells, with hyperchromatic nuclei and scanty cytoplasm (H&E staining, ×400). The neoplasm displayed focal expression of CgA (B), strong and diffused expression of Syn (C) and partial, weak to moderate expression of NSE (the red arrow) (D).
Abbreviations: SCC, small cell carcinoma; H&E, hematoxylin and eosin; NSE, neuron specific enolase; CgA, Chromogranin A; Syn, synaptophysin.

Table 1 Patient characteristics in our series

Case no	Age/gender	Symptom	Side/location	Maximum diameter (cm)	Other components	Staging	Surgery	Immunohistochemical staining			Chemotherapy	Follow-up (month, status)
								NSE	CgA	Syn
1	62/M	Asymptomatic	Left/upper	10.5	UC/lymphoma/sarcoma	T3N0M0	LNU	Partial+	Partial+	Partial+	Yes	4, DOD
2	64/F	Painless hematuria	Left/upper	2	No	T3N1M0	LNU + LND	+	Partial+	−	Yes	9, AWNR
3	62/F	Painless hematuria	Right/upper	3	No	T4N0M0	LNU + LND	+	−	−	No	6, AWNR
4	56/M	Painless hematuria	Right/lower	2.5	UC/sarcoma	T3N0M0	LNU	Partial+	−	Partial+	No	6, AWR

Notes: −, stained positive cells <3% of all tumor cells; partial+, stained positive cells 3–30% of all tumor cells; +, stained positive cells >30% of all tumor cells.

Abbreviations: AWNR, alive with no evidence of recurrence; AWR, alive with recurrence; DOD, dead of disease; LND, lymph node dissection; LNU, laparoscopic nephroureterectomy; UC, urothelial carcinoma; M, male; F, female; NSE, neuron specific enolase; CgA, Chromogranin A; Syn, synaptophysin.

Table 2 Clinicopathologic characteristics and therapy of patients

Data	N (%), median (range)
Age (31 available) (years)	66.6±8.8 (48–80)
≥65	19 (61.3)
<65	12 (38.7)
Gender (31 available)
Male	22 (71.0)
Female	9 (29.0)
Side (25 available)
Left	11 (44.0)
Right	14 (56.0)
Location (23 available)
Upper	4 (17.4)
Middle	3 (13.0)
Lower	16 (69.6)
Histology (32 available)
Pure	17 (53.1)
Mixed	15 (46.9)
T stage (28 available)
T1–2	9 (32.1)
T3–4	19 (67.9)
Lymph node invasion (28 available)
N0	20 (71.4)
N+	8 (28.6)
Surgery (29 available)
RNU	25 (86.2)
Ureterectomy	3 (10.3)
Others	1 (3.5)
Chemotherapy (27 available)
Yes	12 (44.4)
No	15 (55.6)

Abbreviation: RNU, radical nephroureterectomy.

Figure 2 Overall Kaplan–Meier survival curves for patients with ureteral SCC.

Notes: (A) Survival of all patients. (B) Gender-adjusted patient survival. (C) Survival of patients stratified according to tumor components. (D) Survival of patients stratified according to T stage.
Abbreviations: OS, overall survival; SCC, small cell carcinoma.

Table 3 Univariate analysis of prognostic factors for OS of the patients

Data	N (n of death)	Univariate analysis
		HR	95% CI	P-value
Gender		5.769	1.555–21.405	0.009*
Male	22 (11)
Female	9 (6)
Age (years)		0.352	0.112–1.101	0.07
≥65	19 (13)
<65	12 (4)
Side		0.793	0.432–1.457	0.46
Left	11 (5)
Right	14 (8)
Histology		3.144	1.099–8.991	0.03*
Mixed	15 (7)
Pure	17 (11)
T stage		5.047	1.098–23.200	0.04*
T1–2	9 (2)
T3–4	19 (13)
Lymph node invasion		0.918	0.114–7.389	0.94
N0	20 (9)
N+	4 (2)
Chemotherapy		0.843	0.235–3.024	0.79
Yes	10 (4)
No	15 (10)

Note:

* P-value <0.05.

Abbreviation: OS, overall survival.