Distant metastasis without regional progression in non-muscle invasive bladder cancer: case report and pooled analysis of literature

Abstract

Background Non-muscle invasive bladder cancer (NMIBC) represents the majority of bladder neoplasms. It is unusual for NMIBC metastasizing distantly without regional progression, namely metastatic NMIBC (mNMIBC), which is still poorly understood and easily omitted based on current management policies. So far, description of mNMIBC is limited to a few case reports. Methods We reported a 70-year-old man with NMIBC who suffered from cervical metastasis without pelvic recurrence at 41 months after initial diagnosis. Then we performed a collective analysis of this case together with published mNMIBC cases searched from PubMed, Embase, and Web of Science, aiming to illustrate baseline clinicopathologic parameters, metastatic patterns, and treatment outcomes of these patients and analyze associated influencing factors. Results After scrupulous review, 45 cases previous reported and the one from our center were incorporated into the aggregated cohort of mNMIBC, including 34 males and 12 females. Primary tumors from 46.7% of patients were high-grade (HG) or grade 3 (G3) and 65.1% had T1 lesions. Aberrant biomarker expression was found in tumors of some cases. Most (40/46) metastases of mNMIBC occurred at a single site, mainly in lung, bone and lymph nodes. Apart from three cases of de novo mNMIBC, the mean metastasis-free survival (MFS) interval of metachronous mNMIBC was 42.5 months, which was obviously longer than conventional metastatic bladder cancer. Shortened MFS interval was associated with old age, T1 or HG/G3 primary tumors, and non-lung metastases. Systemic chemotherapy and metastasectomy or radiotherapy for oligometastatic lesion were main therapeutic approaches of mNMIBC, and immunotherapy was adopted for the case from our center. Lung and bone metastases correlated with relatively favorable and unfavorable survival outcomes, respectively. Compared with monotherapy, chemotherapy, or immunotherapy combined with local cytoreduction got more favorable outcomes. Conclusion Although rare, mNMIBC occurs more in tumors with high-risk features. Usually, mNMIBC metastasizes later than conventional metastatic bladder cancer and manifests as solitary lesion. Outcomes of mNMIBC would be influenced by metastatic site and post-metastatic treatment. Systemic treatment combined with local cytoreduction may render survival benefit in selected patients.

Definitions, outcomes and perspectives for oligometastatic bladder cancer: towards a standardized terminology

“…In primary omBCa, inductive therapy will most likely consist of systemic therapy. However, in patients ineligible for immediate systemic therapy, local therapy such as surgery or radiotherapy could be considered (Table 1) [48][49][50][51][52].…”

“…However, the indications and the setting of the procedure were not available for stratification [47]. Finally, a literature review on rare cases of metastatic nonmuscle-invasive bladder cancer was published, demonstrating a high rate of local therapy in these cases (66%); more favourable results are probably obtained by combining systemic and local treatments [48].…”

Multimodal AI for prediction of distant metastasis in carcinoma patients

“…Pancreatic cancer is usually diagnosed at a late stage, and DM is quite common at presentation, however, multidetector computed tomography (MDCT) which is currently the optimal preoperative investigation has poor sensitivity to liver and peritoneal metastasis, the most common metastatic sites ( Liu et al, 2018 ). Cases of metastatic non-muscle-invasive bladder cancer have also been reported ( Xu et al, 2022 ). Early diagnosis of metastatic cancer is critical if patients will benefit from systemic therapies, alongside other appropriate management plans.…”