Long-Term Results and Prognostic Factors of Pulmonary Metastasectomy in Patients with Metastatic Transitional Cell Carcinoma

Abstract

We wanted to assess the prognostic factors and the efficacy of the treatment in patients who underwent lung resections for transitional cell carcinoma metastases. This is a retrospective, multicenter study. Between January 1995 and May 2014, 69 patients underwent lung metastasectomy with curative intent. We evaluated primary site of the tumor, the role of adjuvant chemotherapy after urological operation, disease-free interval (DFI; lower or higher than 24 months), type of lung resection, number of lung metastases, presence of metastatic lymph nodes, and diameter of the metastasis (less or more than 3 cm). Among 69 patients, 55 (79%) had bladder as primary site of disease and 12 of them received a transurethral bladder resection. Fourteen (21%) patients developed primary tumor in the renal pelvis or ureter; 53 (76%) patients presented with a single metastasis, 16 (24%) with multiple metastasis. The median DFI was 37 months and the median follow-up was 50 months. Sampling lymphadenectomy was done in 42 patients and nodal metastases were found in 7 patients. The overall 5-year survival was 52%, median 62 months. At univariate analysis, the DFI had a significant impact on survival (5-year survival of 58% for patients with DFI ≥ 24 months vs. 46%; = 0.048) and diameter of metastasis (5-year survival of 59% for diameter less than 3 cm group vs. 33%; = 0.001). The multivariate analysis confirmed metastasis' diameter as an independent prognostic factor ( = 0.001). Our study found that, in addition to DFI that remains a common prognostic factor in patients with metastatic lung disease, in lung metastases by transitional cell carcinoma, the diameter of the lesion is another significant prognostic factor.

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

“…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.…”

“…24 Subsequent studies with a majority of the cohort undergoing pulmonary metastasectomy showed a 5-year OS ranging from 33% to 52%, with solitary pulmonary disease or nodules <3 cm also portending better outcomes. 8,15,17,18,20 Importantly, in the NCDB, we were unable to determine the site of metastasectomy, only the location of metastatic disease present in the patient. With this limitation in mind, we found a survival benefit associated with metastasectomy in >1500 patients with pulmonary involvement.…”

Metastases of Urothelium Carcinoma: Differential Diagnosis, Resection, and Survival

“…The examinations of Luzzi et al, Abe et al, and Faltas et al also arrived at the same result. 18,24,25 In contrast, Siefker-Radtke et al observed an indication for a metastases surgery in the case of a metastasized urothelial carcinoma, provided that a good response from chemotherapy can be recorded. 20 Accordingly, we could prove this in the cases of other tumor entities.…”

“…Luzzi et al observed a median survival of 62 months, with a 5-year survival of 52%, in one of the largest collective samples of patients, including 69 patients who had a lung metastasis of a urothelial carcinoma. 18 Other authors emphasize size in addition to the number of metastases. Muilwijk et al described that metastases more than 8 mm are associated with a worse prognosis.…”

Palliative Chirurgie beim metastasierten Urothelkarzinom

“…Das mediane Überleben war 62 Monate, mit einem Intervall von 37 Monaten bis zur Progression nach der Operation. Die Größe der Metastasen ( < / > 3 cm) sowie die Zeit bis zur Progression waren unabhängige prognostische Marker für das Gesamtüberleben (p = 0,001) [18].…”