Pulmonary Metastasectomy Could Prolong Overall Survival in Select Cases of Metastatic Urinary Tract Cancer

Kim, Tae‐Eun; Ahn, Jin‐Hee; You, Dalsan; Jeong, I.G.; Hong, Bumsik; Hong, Jun Hyuk; Ahn, Hanjong; Lee, Jae‐Lyun

doi:10.1016/j.clgc.2015.04.013

Cited by 29 publications

(29 citation statements)

References 22 publications

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“…2. These studies, including 96 patients, reported 5-year OS ranging from 46.5% to 85.3% except for one study which only reported 3-year OS (41%) [29]. Only two of the studies reported 5-year PFS [26, 31], which ranged from 26% to 50%.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies reported that solitary metastases were independently associated with better prognosis [30, 32] with 5-year OS ranging from 83.3% (HR not reported) to 85.7% (HR not reported, p = 0.009). Another study [29] showed a much longer PFS (68 months vs. 7 months, p < 0.001) in the group with solitary metastasis when compared to those patients with multiple metastatic pulmonary lesions. Furthermore, one study [26] also showed that solitary metastases <3 cm (HR 4.72, p = 0.006) were associated with improved outcomes compared with patients with larger metastases.…”

Section: Resultsmentioning

confidence: 99%

“…All the studies, except one [29], included cases with only pulmonary metastases (and not other sites) amenable to resection. Between these different studies, there were no uniform guidelines regarding number of times metastectomy can be performed and use of chemotherapy in the post-metastectomy setting.…”

Section: Resultsmentioning

confidence: 99%

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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%

Section: Resultsmentioning

confidence: 99%

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

Patel

Lorduy

Stern

et al. 2017

BLC

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“…A retrospective study of 44 patients treated across 15 German centres reported a 5-year survival rate of 28% [54], and in a series of 42 patients from Japan treated by metastasectomy, in patients with solitary nodal or lung metastasis (15 patients), the median OS reached 81 months [55]. A small series from Korea [49] also supported these conclusions. As summarised in a recent collaborative systematic review in metastatic bladder cancer [56], the beneficial role of metastasis surgery remains unproven by a prospective trial but may be considered in those with low volume Table 2)…”

Section: Number Of Metastatic Sites Consistent With Possible Curementioning

confidence: 85%

“…Although the finding of OMD may offer hope of cure, for the responsible clinician, an important consideration is the avoidance of toxicities associated with radical therapies in a palliative setting. There are few published series about the radical treatment of OMD in urothelial cancers; hence, no guidelines have addressed its management [49]. Thus, questions need to be addressed, at least in part, by reference to other cancers or other disease stages.…”

Section: The Role Of Treatment Of Curative Intent In Omdmentioning

confidence: 99%

EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees

et al. 2019

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These consensus statements were developed by the European Association of Urology (EAU) and the European Society for Medical Oncology (ESMO) and are published simultaneously in European Urology and Annals of Oncology. Background: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. Objective: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. Design: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference. Setting: Online Delphi survey and consensus conference. Participants: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.

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A case of complete response following the administration of pembrolizumab and metastasectomy for lung and bone metastases of bladder cancer

et al. 2021

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Introduction Patients with metastatic urothelial carcinoma have poor prognosis and limited treatment options. Case presentation The patient was a 60‐year‐old male with bladder cancer and multiple lung metastases. He underwent three courses of gemcitabine and cisplatin chemotherapy, despite left femoral bone metastases. Tumor resection and bone replacement surgery was performed. Following the administration of four courses of pembrolizumab, lung metastasis completely resolved. However, after nine courses, right femoral neck bone metastasis was observed; therefore, tumor resection and bone replacement surgery were repeated. Pathologically, PD‐L1 expression was low in lung biopsy tissue and bone metastases. Pembrolizumab treatment continued for up to 20 courses; cancer recurrence and adverse events were not observed upon follow‐up examination after 1 year. Conclusion Patients responding well to systemic therapy may have resectable metastatic sites, and long‐term survival might be achieved with adjunctive metastasectomy. The effect of pembrolizumab was not associated with positive PD‐L1 expression.

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Pulmonary Metastasectomy Could Prolong Overall Survival in Select Cases of Metastatic Urinary Tract Cancer

Cited by 29 publications

References 22 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

EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees

A case of complete response following the administration of pembrolizumab and metastasectomy for lung and bone metastases of bladder cancer

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