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. 2020 Jun;9(3):1296-1305.
doi: 10.21037/tau-19-624.

Metastasectomy of oligometastatic urothelial cancer: a single-center experience

Tim Muilwijk  1 , Murat Akand  1   2 , Frank Van der Aa  1 , Herlinde Dumez  3 , Gert De Meerleer  4 , Dirk Van Raemdonck  5 , Paul De Leyn  5 , Hendrik Van Poppel  1 , Maarten Albersen  1 , Steven Joniau  1
Affiliations

Metastasectomy of oligometastatic urothelial cancer: a single-center experience

Tim Muilwijk et al. Transl Androl Urol. 2020 Jun.

Abstract

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.

Keywords: Urothelial cancer (UC); metastasectomy; metastatic urothelial cancer (metastatic UC); oligometastatic; recurrence; solitary metastasis; surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tau-19-624). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of patients’ selection process.
Figure 2
Figure 2
OS of all patients: the 5-year OS was 51.4% (95% CI: 32.4–81.4) with a median OS of 98.2 months (95% CI: 23.4–NR). Dotted lines are the CI. OS, overall survival; CI, confidence interval; NR, not reached.
Figure 3
Figure 3
Therapeutic flow of all patients undergoing metastasectomy (n=22).
Figure 4
Figure 4
Therapeutic flow of patients undergoing a pulmonary metastasectomy (n=13).
Figure S1
Figure S1
OS of all patients (n=20) that did not receive any CHT prior to metastasectomy with a median OS of 98.2 months (IQR: 23.4–NR). Dotted lines are the CI. OS, overall survival; CHT, chemotherapy; IQR, interquartile range; NR, not reached; CI, confidence interval.
Figure S2
Figure S2
OS, CSS, and RFS2 of all patients (n=22) stratified by primary UTUC involvement (A,B,C) or treatment with hepatic metastasectomy (liver M+) (D,E,F). Patients with primary UTUC involvement or patients treated with hepatic metastasectomy had a significant worse OS, CSS, and RFS2. Dotted lines are the CI. OS, overall survival; CSS, cancer-specific survival; RFS2, secondary recurrence-free survival; UTUC, upper tract urothelial cancer; CI, confidence interval.
Figure S3
Figure S3
CSS of patients (n=20) with available data regarding tumor size stratified by lesion size: ≤8 vs. >8 mm. Patients with a lesion size >8 mm had a significant worse CSS. Dotted lines are the CI. CSS, cancer-specific survival; CI, confidence interval.
Figure S4
Figure S4
CSS of patients treated with pulmonary metastasectomy (n=13) stratified by number of lesions: solitary vs. >1. Patients with more than one lesion had a significant worse CSS. Dotted lines are the CI. CSS, cancer-specific survival; CI, confidence interval.
See this image and copyright information in PMC

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