Could salvage surgery after chemotherapy have clinical impact on cancer survival of patients with metastatic urothelial carcinoma?

Bekku, Kensuke; Sakaguchi, Takashi; Kobayashi, Yasuyuki; Kioshimoto, Ryo; Kanbara, Takeshi; Nasu, Yasutomo; Kumon, Hiromi

doi:10.1007/s10147-011-0350-z

Cited by 14 publications

(9 citation statements)

References 18 publications

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“…There was variability in the number of patients who received chemotherapy either before or after metastasectomy. Additionally, there was heterogeneity in the response to chemotherapy prior to metastasectomy; four studies [21, 23–25] included patients undergoing metastasectomy after achieving a CR to chemotherapy, one study [22] included only patients with PR to chemotherapy, and one study [20] included only patients that were refractory to chemotherapy. Interestingly in this study, those patients who underwent metastasectomy for palliative purposes had a significant improvement in quality-of-life (WHO performance score 3.3 to 2.1, p = 0.005).…”

Section: Resultsmentioning

confidence: 99%

Survival after Metastasectomy for Metastatic Urothelial Carcinoma: A Systematic Review and Meta-Analysis

Patel

Lorduy

Stern

et al. 2017

BLC

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Background: Cisplatin-based combination chemotherapy is standard treatment for metastatic urothelial carcinoma; however, the vast majority of patients experience disease progression. As systemic therapy alone is rarely curative for the treatment of metastatic urothelial cancer, not only are new therapies needed but also refinement of general treatment principles. Herein, we conducted a systematic review and meta-analysis to explore the role of metastasectomy in metastatic urothelial carcinoma.Methods: We conducted a systematic review of the literature regarding local treatment for metastatic urothelial carcinoma. An online electronic search of the PubMed/MEDLINE and EMBASE databases was performed to identify peer-reviewed articles. All procedures were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Information was then extracted including number of patients, gender, the site of the primary urothelial tumor, site of metastasis, chemotherapy before or after metastasectomy, overall survival (OS), and disease specific survival (DSS) after metastasectomy. A meta-analysis was performed with those studies with sufficient survival data to obtain pooled overall survival. The article quality was assessed using the Cochrane Handbook “risk of bias” tool.Results: Seventeen out of 3963 articles were eligible for review between 1990–2015, including a total of 412 patients. The mean time to recurrence after metastasectomy was 14.25 months. The overall survival from time of metastasectomy ranged from 2 to 60 months. Pooled analyses of studies reported survival data revealed an improved overall survival for patients treated with metastasectomy compared with non-surgical treatment of metastatic lesions (HR 0.63; 95% CI, 0.49–0.81). All, except for three studies, were retrospective and non-randomized, leading to a high risk of bias associated with patient selection, patient attrition, and reporting. Such high potential of selection bias may lead to higher OS than expected. Additionally, treatment and outcome details reported across studies was highly variable.Conclusions: Limited conclusions can be drawn from the available literature exploring the role of metastasectomy in the management of metastatic urothelial cancer due to lack of uniform reporting elements and multiple sources of bias particularly related to a lack of prospective randomized trials. As a subset of patients treated with metastasectomy achieve durable disease control, this approach may be considered for select patients.

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Section: Resultsmentioning

confidence: 99%

Survival after Metastasectomy for Metastatic Urothelial Carcinoma: A Systematic Review and Meta-Analysis

Patel

Lorduy

Stern

et al. 2017

BLC

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“… 13 In 1982, Cowles et al for the first time reported the survival outcomes of six BCa patients with lung metastases and analyzed the function of surgical resection of the solitary pulmonary metastases. 17 Since then, several studies have focused on the survival outcomes in patients with bone, 18 , 19 brain, 19 – 23 liver, 18 lung, 11 , 17 – 19 , 22 , 24 – 26 distant lymph nodes 11 , 18 , 19 , 22 , 26 – 28 and even skin 18 , 19 metastases from BCa. However, few studies focused on the survival differences between patients with different kinds of metastases and no study about BCa paid attention to the important role of the number of metastatic sites and patients with a single metastatic site.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of site-specific metastases and therapeutic roles of surgery for patients with metastatic bladder cancer: a population-based study

Fan

Shen

Gao

et al. 2017

CMAR

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BackgroundWe aimed to evaluate the prognostic value of site-specific metastases in patients with metastatic bladder cancer and analyze the roles that surgeries play in the treatment of this malignancy.Materials and methodsA population-based retrospective study using Surveillance, Epidemiology and End Results dataset was performed and metastatic bladder cancer patients were classified according to the sites of metastases (bone, brain, liver, lung and distant lymph nodes). Kaplan–Meier analysis with log-rank test was used for survival comparisons. Multivariate Cox regression model was employed to analyze the effect of distant metastatic sites on overall survival (OS) and cancer-specific survival (CSS).ResultsA total of 1862 patients with metastatic bladder cancer from 2010 to 2014 were identified. Bone, lung and distant lymph nodes were the most common metastatic sites. Patients with bone, brain, liver and lung involvement had worse OS and CSS compared to patients without the corresponding sites of metastases. Multivariate analysis showed that bone, brain, liver and lung metastases were independent prognostic factors for both OS and CSS, while distant node metastasis was not. Moreover, patients with a single metastatic site had more favorable OS (p<0.001) and CSS (p<0.001) than patients with multisite metastases. Among single-site metastatic patients, distant nodes and liver metastases represented the best and the worst prognosis, respectively. Moreover, radical cystectomy was an independent predictor for better OS and CSS, while in patients with liver metastasis and multiple metastatic sites, RC did not bring benefits. Besides, in patients with a single metastatic site, metastasectomy seemed to be associated with favorable OS (p=0.042), especially for patients with age <65 years (p=0.006) and for muscle-invasive bladder cancer patients (p=0.031).ConclusionDistant metastatic sites have differential impact on survival outcomes in patients with metastatic bladder cancer. Surgeries, including radical cystectomy and metastasectomy, might still lead to survival benefits for highly selected patients.

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“…12 There is minimal, high-quality data evaluating the role of metastasectomy in urothelial carcinoma (Table 3). [5][6][7][8][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] A recent Surveillance, Epidemiology and End Results-Medicare study evaluating survival outcomes for 497 patients with metachronous metastases who underwent metastasectomy found poor median OS of 19 months and 3-year survival of 38% compared with a median OS of 7 months in the synchronous metastasectomy group in the present study. 5 This difference might reflect the difference in tumor biology and disease burden at the time of metachronous versus synchronous metastases.…”

Section: Discussionmentioning

confidence: 75%

Predictors of use and overall survival for patients undergoing metastasectomy for bladder cancer in a national cohort

et al. 2020

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Objectives To determine the use of surgical resection of metastatic disease in a large national sample and its association with overall survival. Methods The National Cancer Database was queried for patients with metastatic bladder cancer (2004–2016). Overall survival was assessed using Kaplan–Meier and multivariable Cox analyses. The associations between covariates and use of metastasectomy were assessed with multivariable logistic regression. Results Of the 16 382 patients with metastatic bladder cancer included, 6.8% underwent metastasectomy. Its use increased over time (4.7% in 2004 to 6.6% in 2016; per year odds ratio 1.02, 95% confidence interval 1.00–1.04, P = 0.019). Median survival was 7.0 months for patients who received metastasectomy and 5.1 months for those who did not (hazard ratio 0.85, 95% confidence interval 0.79–0.91, P < 0.001). In subgroup analyses, metastasectomy predicted longer survival in patients with lung (hazard ratio 0.73, 95% confidence interval 0.61–0.88, P = 0.001) or brain metastases (hazard ratio 0.58, 95% confidence interval 0.35–0.96, P = 0.035) and in patients with variant histology (hazard ratio 0.80, 95% confidence interval 0.69–0.93, P = 0.003). Conclusions In a national sample, the use of metastasectomy for bladder cancer is low. Furthermore, metastasectomy is associated with longer survival overall and in multiple subgroups. However, these results should be validated in future studies.

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Could salvage surgery after chemotherapy have clinical impact on cancer survival of patients with metastatic urothelial carcinoma?

Abstract: Salvage surgery for patients with residual tumor who achieve partial response to chemotherapy could have a possible impact on cancer survival.

Cited by 14 publications

References 18 publications

Survival after Metastasectomy for Metastatic Urothelial Carcinoma: A Systematic Review and Meta-Analysis

Survival after Metastasectomy for Metastatic Urothelial Carcinoma: A Systematic Review and Meta-Analysis

Prognostic value of site-specific metastases and therapeutic roles of surgery for patients with metastatic bladder cancer: a population-based study

Predictors of use and overall survival for patients undergoing metastasectomy for bladder cancer in a national cohort

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