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. 2022 Nov 4:9:1045831.
doi: 10.3389/fsurg.2022.1045831. eCollection 2022.

The predictors and surgical outcomes of different distant metastases patterns in upper tract urothelial carcinoma: A SEER-based study

Xuan-Han Hu  1 , Jia Miao  2 , Lin Qian  3 , Da-Hong Zhang  3 , Hai-Bin Wei  3
Affiliations

The predictors and surgical outcomes of different distant metastases patterns in upper tract urothelial carcinoma: A SEER-based study

Xuan-Han Hu et al. Front Surg. .

Abstract

The purpose of this study was to investigate the predictors of metastatic patterns of upper tract urothelial carcinoma (UTUC) and to analyze the surgical outcomes of different metastatic patterns of UTUC. Data on patients with UTUC from 2010 to 2017 were retrieved from the Surveillance, Epidemiology, and End Results Program (SEER) database. Kaplan-Meier analysis was applied to compare the patients' survival distributions. Univariate and multivariate logistic regression was used to assess the specific predictors of site-specific metastases, while competitive risk regression was applied to estimate the predictors of cancer-specific mortality in patients with metastases. A total of 9,436 patients were enrolled from the SEER database, of which 1,255 patients had distant metastases. Lung metastasis (42.5%) was most common and patients with single distant lymph node metastasis had a better prognosis. Clinical N stage (N1, N2, N3) was the strongest predictors of the site specific metastatic sites. Renal pelvis carcinoma was more prone to develop lung metastases (OR = 1.67, P < 0.01). Resection of the primary tumor site is beneficial for the prognosis of patients with metastatic UTUC, whether local tumor resection (HR = 0.72, P < 0.01) or nephroureterectomy (HR = 0.64, P < 0.01). Patients with single distant lymph node metastasis have the greatest benefit in nephroureterectomy compared to other specific-site metastases (median survival 19 months vs. 8 months). An understanding of distant metastatic patterns and surgical outcomes in patients with UTUC is important in clinical settings and helpful in the design of personalized treatment protocols.

Keywords: SEER (Surveillance epidemiology and end results) database; competition risk; metastatic patterns; surgery; upper tract urothelial carcinoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Venn diagram of the distribution of distant metastatic sites.
Figure 2
Figure 2
ROC analysis for evaluating the discrimination of logistic model. (A) ROC in the training set for metastases at all sites. (B) ROC in the validation set. for metastases at all sites. (C) ROC in the training set for lung metastases. (C) ROC in the validation set for lung metastases. (E) ROC in the training set for bone metastases (F) ROC in the validation set for bone metastases. (G) ROC in the training set for liver metastases. (H) ROC in the validation set for liver metastases. (I) ROC in the training set for brain metastases. (J) ROC in the validation set for brain metastases. (K) ROC in the training set for distant lymph node metastases. (L) ROC in the validation set for distant lymph node metastases.
Figure 3
Figure 3
Kaplan-Meier curves of OS and CSS according to single site-specific metastasis. (A) OS in single site-specific metastasis (B) CSS in single site-specific metastasis. OS, overall survival, CSS, cancer-specific survival.
Figure 4
Figure 4
Kaplan-Meier curves for OS and CSS according to number of distant metastases. (A) OS in single metastasis and multiple metastases; (B) CSS in single metastasis and multiple metastases. OS, overall survival, CSS, cancer-specific survival.
Figure 5
Figure 5
Kaplan-Meier curves for OS and CSS according to surgical methods. (A) OS in single metastasis; (B) CSS in single metastasis; (C) OS in multiple metastasis; (D) CSS in multiple metastasis. OS,overall survival; CSS, cancer-specific survival.
See this image and copyright information in PMC

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