<p>Role of Multimodal Treatment in Urothelial Carcinoma Spinal Metastasis: 15 Patients’ Experiences in a Single Center</p>

Abstract

Spinal metastasis from urothelial carcinoma (UC) is relatively uncommon. The aim of the present study is to explore the clinicopathological features, surgical treatments and outcomes of this rare disease. Patients and Methods: Fifteen patients with UC spinal metastasis who received surgery in our center between 2009 and 2018 were retrospectively investigated. Clinical data, treatment options, and outcomes were analyzed. Results: For the 15 patients (9 men and 6 women), the primary tumors were located in the upper urothelial tract in ten and lower urothelial tract in five. UC mainly metastasized to the lumbar spine in seven cases, followed by the thoracic spine in five. Pathologic fracture and soft tissue mass with dura mater compression were observed in 66.7% and 93.3% cases, respectively. Palliative resection was performed in nine cases and excisional resection in six. Eleven patients received postoperative chemotherapy, including three with a preoperative ECOG score >2. Bisphosphonates were administered in all patients. Pain was relieved remarkably in all patients, and both the neurological function and general status were improved significantly after surgery. The median overall survival was 14 months. Log rank test showed that patients receiving postoperative chemotherapy survived longer than those without chemotherapy (p=0.037). WHO grade 3 was also correlated with poorer prognosis (p=0.012). Conclusion: Pathological fracture and soft tissue mass with dura mater compression is frequently observed on radiological images in patients with UC spinal metastasis. Surgery is useful to prevent deterioration of performance status and improve quality of life, which provide an opportunity for further systematic therapy. Multimodal treatments, including surgery, postoperative chemotherapy and bisphosphonates are recommended. WHO grade 2 and receiving postoperative chemotherapy were favorable prognostic factors for the overall survival of patients with UC spinal metastasis.

Urothelial Carcinoma With Bone Metastasis Mimicking Sciatica: A Common Neoplasm With an Uncommon Presentation

“…It is divided into the upper tract (involving the renal pelvis and ureter) UC and the lower tract (involving the bladder and urethra) UC. It can also be classified into low-grade (grade 1) and high-grade (grades 2 and 3) lesions depending upon the oncological behaviors, according to the WHO [2]. The presence of bone metastasis with or without pulmonary or liver involvement is defined as visceral metastasis from UC, which is recognized as a negative prognostic factor in a model developed at the Memorial Sloan Kettering Cancer Center and Karnofsky performance status in patients receiving cisplatin-based chemotherapy [1].…”

“…UC is associated with about 10.1% of the metastasis rate, has a poor prognosis, and is uniformly fatal. The median overall survival varies from 5.4 to 15 months, and 10.8 months for bone metastasis as the only metastatic site in urothelial metastasis [2]. Spinal metastasis is relatively rare, accounting for about 58.3% of all UC metastases.…”

“…The patients should understand the long-term prognosis and treatment options available [9]. These patients demand special attention as bone metastasis has a less favorable prognosis as compared to other metastatic sites [10] and also due to the high rate of skeletal-related events like severe spinal instability, intractable pain, and poor life quality, which is a big factor in restricting the application of chemotherapy [2]. Non-operative treatment is advised when tumor involvement has not led to spinal instability, neurological involvement, or intractable pain unresponsive to medical management and includes radiotherapy, chemotherapy, hormonal therapy, and high-dose steroid therapy.…”

“…The incidence of bone metastasis in bladder cancer is between 1.39 to 5.5% as synchronous metastatic disease and 30 to 40% as metasynchronous metastatic disease [1]. UC metastasis has a male predominance (60%) with a median age of 66.5 years in the patients [2]. Typical bone metastasis is osteolytic (70%), but UC can also cause osteoblastic lesions (10%), although rare [3].…”