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

Abstract

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.

Is there a role for metastasis-directed therapy in bladder cancer?

“…Despite having a relatively large sample of patients who underwent metastasectomy ( n = 817), the absence of data on site-specific metastases raises the possibility that outcomes might differ in certain subgroups if such data were available. Indeed, Weiner et al [20] previously reported, in a subgroup analysis using the NCDB, that variant histology, <cT3 disease stage, or the resecting lung or brain metastases were associated with significantly longer survival.…”

Adrenalectomy for Metastasis: The Impact of Primary Histology on Survival Outcome

“…Adrenal metastases from bladder cancer are less common and data concerning oncological outcomes are still lacking. Weiner et al, analyzing data from the National Cancer Database, found an improved OS for patients with metastatic bladder cancer who received metastasectomy at any site, compared to non-surgically treated patients (HR 0.85, 95%CI 0.79-0.91, p < 0.001) [26]. In the present series, we reported two cases of adrenal metastasectomy for bladder cancer that showed a 1-year CSS probability of 50%; at multivariable analysis, bladder cancer histology displayed a negative impact on survival outcomes compared to adrenalectomy for RCC (HR 75.49; 95% CI 5.90-965; p = 0.001).…”

Impact of Salvage Cytotoxic Chemotherapy on Prognosis in Patients with Recurrence After Radical Cystectomy: A Multi-Institutional Retrospective Study

“…Furthermore, evidence has been increasing that ncRNA expression is associated with cisplatin resistance, especially in ovarian cancer, in which debulking surgery has been widely accepted into clinical practice [31]. Although a recent review of in vitro experiments showed such an association between ncRNA and cisplatin resistance, the role of metastasectomy in BCa remains unclear because of the lack of a randomized setting [32,33]. As a meta-analysis showed that the therapeutic effect not only of CC but also of ICIs for liver metastasis from urothelial cancer seemed to be transient [34], surgical consolidation for metastasis might be a key to achieving long-term survival in selected conditions.…”