Prognostic value of site-specific metastases and therapeutic roles of surgery for patients with metastatic bladder cancer: a population-based study

Fan Dong, Yifan Shen, Fengbin Gao, Tianyuan Xu, Xianjin Wang, Xiaohua Zhang, Shan Zhong, Minguang Zhang, Shanwen Chen, Zhoujun Shen, Fan Dong, Yifan Shen, Fengbin Gao, Tianyuan Xu, Xianjin Wang, Xiaohua Zhang, Shan Zhong, Minguang Zhang, Shanwen Chen, Zhoujun Shen

Abstract

Background: We aimed to evaluate the prognostic value of site-specific metastases in patients with metastatic bladder cancer and analyze the roles that surgeries play in the treatment of this malignancy.

Materials and methods: A population-based retrospective study using Surveillance, Epidemiology and End Results dataset was performed and metastatic bladder cancer patients were classified according to the sites of metastases (bone, brain, liver, lung and distant lymph nodes). Kaplan-Meier analysis with log-rank test was used for survival comparisons. Multivariate Cox regression model was employed to analyze the effect of distant metastatic sites on overall survival (OS) and cancer-specific survival (CSS).

Results: A total of 1862 patients with metastatic bladder cancer from 2010 to 2014 were identified. Bone, lung and distant lymph nodes were the most common metastatic sites. Patients with bone, brain, liver and lung involvement had worse OS and CSS compared to patients without the corresponding sites of metastases. Multivariate analysis showed that bone, brain, liver and lung metastases were independent prognostic factors for both OS and CSS, while distant node metastasis was not. Moreover, patients with a single metastatic site had more favorable OS (p<0.001) and CSS (p<0.001) than patients with multisite metastases. Among single-site metastatic patients, distant nodes and liver metastases represented the best and the worst prognosis, respectively. Moreover, radical cystectomy was an independent predictor for better OS and CSS, while in patients with liver metastasis and multiple metastatic sites, RC did not bring benefits. Besides, in patients with a single metastatic site, metastasectomy seemed to be associated with favorable OS (p=0.042), especially for patients with age <65 years (p=0.006) and for muscle-invasive bladder cancer patients (p=0.031).

Conclusion: Distant metastatic sites have differential impact on survival outcomes in patients with metastatic bladder cancer. Surgeries, including radical cystectomy and metastasectomy, might still lead to survival benefits for highly selected patients.

Keywords: Epidemiology and End Results; Surveillance; bladder cancer; metastasectomy; metastatic site; prognosis; radical cystectomy.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Venn diagram of the distribution of distant metastatic sites in the overall cohort.
Figure 2
Figure 2
Kaplan–Meier curves of overall survival and cancer-specific survival according to whether or not patients had bone (A, B), brain (C, D), liver (E, F), lung (G, H) and distant lymph node (I, J) metastases.
Figure 3
Figure 3
Kaplan–Meier curves of overall survival (A) and cancer-specific survival (B) according to the number of metastatic sites.
Figure 4
Figure 4
Kaplan–Meier curves of overall survival (A) and cancer-specific survival (B) according to the sites of metastases in patients with single metastatic site.
Figure 5
Figure 5
Kaplan–Meier curves of overall survival and cancer-specific survival according to whether or not radical cystectomy has been done for the overall cohort (A, B), in patients with single metastatic site (C, D) and in patients with multiple metastatic sites (E, F).
Figure 6
Figure 6
Kaplan–Meier curves of overall survival and cancer-specific survival according to whether or not radical cystectomy has been done for patients with bone-only (A, B), liver-only (C, D), lung-only (E, F) and distant node-only (G, H) metastases.
Figure 7
Figure 7
Kaplan–Meier curves of overall survival and cancer-specific survival according to whether or not metastasectomy has been done for all patients with single metastatic site (A, B), single metastatic patients with age <65 years (C, D), single metastatic female patients (E, F) and single metastatic patients with muscle-invasive bladder cancer (G, H).

References

    1. Dong F, Xu T, Shen Y, et al. Dysregulation of miRNAs in bladder cancer: altered expression with aberrant biogenesis procedure. Oncotarget. 2017;8(16):27547–27568.
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30.
    1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–E386.
    1. Pruthi RS, Baldwin N, Bhalani V, Wallen EM. Conservative management of low risk superficial bladder tumors. J Urol. 2008;179(1):87–90. discussion 90.
    1. Witjes JA, Compérat E, Cowan NC, et al. EAU- ESTRO-ESUR-SIOG Guidelines. Arnhem: EAU Guidelines Office; 2017. Muscle-invasive and metastatic bladder cancer; pp. 9–10.
    1. Rosenberg JE, Carroll PR, Small EJ. Update on chemotherapy for advanced bladder cancer. J Urol. 2005;174(1):14–20.
    1. Bianchi M, Roghmann F, Becker A, et al. Age-stratified distribution of metastatic sites in bladder cancer: a population-based analysis. Can Urol Assoc J. 2014;8(3–4):E148–E158.
    1. Patel V, Collazo Lorduy A, Stern A, et al. Survival after metastasectomy for metastatic urothelial carcinoma: a systematic review and meta-analysis. Bladder Cancer. 2017;3(2):121–132.
    1. Chen C, Hu L, Chen Y, Hou J. The prognostic value of histological subtype in patients with metastatic bladder cancer. Oncotarget. 2017;8(17):28408–28417.
    1. Taguchi S, Nakagawa T, Uemura Y, et al. Validation of major prognostic models for metastatic urothelial carcinoma using a multi-institutional cohort of the real world. World J Urol. 2016;34(2):163–171.
    1. Abe T, Kitamura H, Obara W, et al. Outcome of metastasectomy for urothelial carcinoma: a multi-institutional retrospective study in Japan. J Urol. 2014;191(4):932–936.
    1. Pond GR, Agarwal N, Bellmunt J, et al. A nomogram including baseline prognostic factors to estimate the activity of second-line therapy for advanced urothelial carcinoma. BJU Int. 2014;113(5b):E137–E143.
    1. von der Maase H, Sengelov L, Roberts JT, et al. Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol. 2005;23(21):4602–4608.
    1. Sternberg CN, Vogelzang NJ. Gemcitabine, paclitaxel, pemetrexed and other newer agents in urothelial and kidney cancers. Crit Rev Oncol Hematol. 2003;46(Suppl):S105–S115.
    1. Kim T, Ahn JH, You D, et al. Pulmonary metastasectomy could prolong overall survival in select cases of metastatic urinary tract cancer. Clin Genitourin Cancer. 2015;13(4):e297–e304.
    1. Matsuguma H, Yoshino I, Ito H, et al. Is there a role for pulmonary metastasectomy with a curative intent in patients with metastatic urinary transitional cell carcinoma? Ann Thorac Surg. 2011;92(2):449–453.
    1. Cowles RS, Johnson DE, McMurtrey MJ. Long-term results following thoracotomy for metastatic bladder cancer. Urology. 1982;20(4):390–392.
    1. Otto T, Krege S, Suhr J, Rubben H. Impact of surgical resection of bladder cancer metastases refractory to systemic therapy on performance score: a phase II trial. Urology. 2001;57(1):55–59.
    1. Lehmann J, Suttmann H, Albers P, et al. Surgery for metastatic urothelial carcinoma with curative intent: the German experience (AUO AB 30/05) Eur Urol. 2009;55(6):1293–1299.
    1. Anderson RS, el-Mahdi AM, Kuban DA, Higgins EM. Brain metastases from transitional cell carcinoma of urinary bladder. Urology. 1992;39(1):17–20.
    1. Mahmoud-Ahmed AS, Suh JH, Kupelian PA, et al. Brain metastases from bladder carcinoma: presentation, treatment and survival. J Urol. 2002;167(6):2419–2422.
    1. Siefker-Radtke AO, Walsh GL, Pisters LL, et al. Is there a role for surgery in the management of metastatic urothelial cancer? The M. D. Anderson experience. J Urol. 2004;171(1):145–148.
    1. Fokas E, Henzel M, Engenhart-Cabillic R. A comparison of radiotherapy with radiotherapy plus surgery for brain metastases from urinary bladder cancer: analysis of 62 patients. Strahlenther Onkol. 2010;186(10):565–571.
    1. Kanzaki R, Higashiyama M, Fujiwara A, et al. Outcome of surgical resection of pulmonary metastasis from urinary tract transitional cell carcinoma. Interact Cardiovasc Thorac Surg. 2010;11(1):60–64.
    1. Matsuguma H, Yoshino I, Ito H, et al. Metastatic Lung Tumor Study Group of Japan Is there a role for pulmonary metastasectomy with a curative intent in patients with metastatic urinary transitional cell carcinoma? Ann Thorac Surg. 2011;92(2):449–453.
    1. Bekku K, Saika T, Kobayashi Y, et al. Could salvage surgery after chemotherapy have clinical impact on cancer survival of patients with metastatic urothelial carcinoma? Int J Clin Oncol. 2013;18(1):110–115.
    1. Sweeney P, Millikan R, Donat M, et al. Is there a therapeutic role for post-chemotherapy retroperitoneal lymph node dissection in metastatic transitional cell carcinoma of the bladder? J Urol. 2003;169(6):2113–2117.
    1. Necchi A, Giannatempo P, Lo Vullo S, et al. Postchemotherapy lymphadenectomy in patients with metastatic urothelial carcinoma: long-term efficacy and implications for trial design. Clin Genitourin Cancer. 2015;13(1):80–86.e1.
    1. Wu SG, Li H, Tang LY, et al. The effect of distant metastases sites on survival in de novo stage-IV breast cancer: a SEER database analysis. Tumour Biol. 2017;39(6) 1010428317705082.
    1. Oweira H, Petrausch U, Helbling D, et al. Prognostic value of site-specific metastases in pancreatic adenocarcinoma: a surveillance epidemiology and end results database analysis. World J Gastroenterol. 2017;23(10):1872–1880.
    1. Bellmunt J, Choueiri TK, Fougeray R, et al. Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens. J Clin Oncol. 2010;28(11):1850–1855.
    1. Sonpavde G, Pond GR, Fougeray R, et al. Time from prior chemotherapy enhances prognostic risk grouping in the second-line setting of advanced urothelial carcinoma: a retrospective analysis of pooled, prospective phase 2 trials. Eur Urol. 2013;63(4):717–723.
    1. Nakagawa T, Hara T, Kawahara T, et al. Prognostic risk stratification of patients with urothelial carcinoma of the bladder with recurrence after radical cystectomy. J Urol. 2013;189(4):1275–1281.
    1. Herr HW, Donat SM, Bajorin DF. Post-chemotherapy surgery in patients with unresectable or regionally metastatic bladder cancer. J Urol. 2001;165(3):811–814.
    1. Gandaglia G, Fossati N, Stabile A, et al. Radical prostatectomy in men with oligometastatic prostate cancer: results of a single-institution series with long-term follow-up. Eur Urol. 2017;72(2):289–292.
    1. Santambrogio R, Opocher E, Costa M, Bruno S, Ceretti AP, Spina GP. Natural history of a randomized trial comparing distal spleno-renal shunt with endoscopic sclerotherapy in the prevention of variceal rebleeding: a lesson from the past. World J Gastroenterol. 2006;12(39):6331–6338.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere