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Metastasectomy of oligometastatic urothelial cancer: a single-center experience

BACKGROUND: Survival in patients with urothelial cancer (UC) recurrence after initial treatment with curative intent is limited and treatment options are sparse. Metastasectomy could be considered a treatment option in selected cases. Identifying prognostic factors for survival can be used to counse...

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Autores principales: Muilwijk, Tim, Akand, Murat, Van der Aa, Frank, Dumez, Herlinde, De Meerleer, Gert, Van Raemdonck, Dirk, De Leyn, Paul, Van Poppel, Hendrik, Albersen, Maarten, Joniau, Steven
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354317/
https://www.ncbi.nlm.nih.gov/pubmed/32676413
http://dx.doi.org/10.21037/tau-19-624
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author Muilwijk, Tim
Akand, Murat
Van der Aa, Frank
Dumez, Herlinde
De Meerleer, Gert
Van Raemdonck, Dirk
De Leyn, Paul
Van Poppel, Hendrik
Albersen, Maarten
Joniau, Steven
author_facet Muilwijk, Tim
Akand, Murat
Van der Aa, Frank
Dumez, Herlinde
De Meerleer, Gert
Van Raemdonck, Dirk
De Leyn, Paul
Van Poppel, Hendrik
Albersen, Maarten
Joniau, Steven
author_sort Muilwijk, Tim
collection PubMed
description BACKGROUND: Survival in patients with urothelial cancer (UC) recurrence after initial treatment with curative intent is limited and treatment options are sparse. Metastasectomy could be considered a treatment option in selected cases. Identifying prognostic factors for survival can be used to counsel patients and aid multidisciplinary teams in making treatment decisions. METHODS: We collected a retrospective case series of patients undergoing metastasectomy for oligometastatic UC between 1999 and 2018 at University Hospitals Leuven. Oligometastatic UC was defined as recurrence of UC in a single organ with ≤3 metastases. Survival outcomes of interest were: overall survival (OS), cancer-specific survival (CSS), and secondary recurrence-free survival (RFS2). Complications were reported using the Clavien-Dindo classification (CDC). Survival analysis are descriptive and were performed using Kaplan-Meier plots to visualize survival data and log-rank was used to compare survival between groups. RESULTS: From 1999 to 2018, a total of 22 patients underwent metastasectomy of oligometastatic UC. Metastasectomy sites were: pulmonary (59.1%), loco-regional (13.6%), hepatic (9.1%), adrenal (4.5%), testicular (4.5%), nodal above aortic bifurcation (4.5%), and renal transplant (4.5%). The 5-year OS, CSS and RFS2 after metastasectomy were 51.4%, 57.0%, and 49.9%, respectively. Patients with primary upper tract urothelial cancer (UTUC) involvement and patients treated with hepatic metastasectomy had a significantly worse OS, CSS, and RFS2. Patients with a lesion size >8 mm and patients with >1 pulmonary lesion had a significantly worse CSS. Two CDC grade 3B occurred during follow-up and were both non-procedure related. CONCLUSIONS: Metastasectomy of oligometastatic UC is feasible and can achieve durable cancer control in a highly selected subgroup of patients. Our results suggest that patients with hepatic metastases or primary UTUC involvement could be considered poor candidates for metastasectomy, while patients with a small (<8 mm) or solitary pulmonary lesion might benefit most. These findings should be validated in multi-institutional collaborations or prospective clinical studies.
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spelling pubmed-73543172020-07-15 Metastasectomy of oligometastatic urothelial cancer: a single-center experience Muilwijk, Tim Akand, Murat Van der Aa, Frank Dumez, Herlinde De Meerleer, Gert Van Raemdonck, Dirk De Leyn, Paul Van Poppel, Hendrik Albersen, Maarten Joniau, Steven Transl Androl Urol Original Article BACKGROUND: Survival in patients with urothelial cancer (UC) recurrence after initial treatment with curative intent is limited and treatment options are sparse. Metastasectomy could be considered a treatment option in selected cases. Identifying prognostic factors for survival can be used to counsel patients and aid multidisciplinary teams in making treatment decisions. METHODS: We collected a retrospective case series of patients undergoing metastasectomy for oligometastatic UC between 1999 and 2018 at University Hospitals Leuven. Oligometastatic UC was defined as recurrence of UC in a single organ with ≤3 metastases. Survival outcomes of interest were: overall survival (OS), cancer-specific survival (CSS), and secondary recurrence-free survival (RFS2). Complications were reported using the Clavien-Dindo classification (CDC). Survival analysis are descriptive and were performed using Kaplan-Meier plots to visualize survival data and log-rank was used to compare survival between groups. RESULTS: From 1999 to 2018, a total of 22 patients underwent metastasectomy of oligometastatic UC. Metastasectomy sites were: pulmonary (59.1%), loco-regional (13.6%), hepatic (9.1%), adrenal (4.5%), testicular (4.5%), nodal above aortic bifurcation (4.5%), and renal transplant (4.5%). The 5-year OS, CSS and RFS2 after metastasectomy were 51.4%, 57.0%, and 49.9%, respectively. Patients with primary upper tract urothelial cancer (UTUC) involvement and patients treated with hepatic metastasectomy had a significantly worse OS, CSS, and RFS2. Patients with a lesion size >8 mm and patients with >1 pulmonary lesion had a significantly worse CSS. Two CDC grade 3B occurred during follow-up and were both non-procedure related. CONCLUSIONS: Metastasectomy of oligometastatic UC is feasible and can achieve durable cancer control in a highly selected subgroup of patients. Our results suggest that patients with hepatic metastases or primary UTUC involvement could be considered poor candidates for metastasectomy, while patients with a small (<8 mm) or solitary pulmonary lesion might benefit most. These findings should be validated in multi-institutional collaborations or prospective clinical studies. AME Publishing Company 2020-06 /pmc/articles/PMC7354317/ /pubmed/32676413 http://dx.doi.org/10.21037/tau-19-624 Text en 2020 Translational Andrology and Urology. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Muilwijk, Tim
Akand, Murat
Van der Aa, Frank
Dumez, Herlinde
De Meerleer, Gert
Van Raemdonck, Dirk
De Leyn, Paul
Van Poppel, Hendrik
Albersen, Maarten
Joniau, Steven
Metastasectomy of oligometastatic urothelial cancer: a single-center experience
title Metastasectomy of oligometastatic urothelial cancer: a single-center experience
title_full Metastasectomy of oligometastatic urothelial cancer: a single-center experience
title_fullStr Metastasectomy of oligometastatic urothelial cancer: a single-center experience
title_full_unstemmed Metastasectomy of oligometastatic urothelial cancer: a single-center experience
title_short Metastasectomy of oligometastatic urothelial cancer: a single-center experience
title_sort metastasectomy of oligometastatic urothelial cancer: a single-center experience
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354317/
https://www.ncbi.nlm.nih.gov/pubmed/32676413
http://dx.doi.org/10.21037/tau-19-624
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