Urologic Oncology: Seminars and Original Investigations
Original articleMetastasectomy in older adults with urothelial carcinoma: Population-based analysis of use and outcomes
Introduction
Metastatic urothelial carcinoma of the bladder, ureter, or renal pelvis is a highly aggressive disease and its treatment remains challenging for clinicians [1]. Patients with metastatic urothelial carcinoma have limited therapeutic options. Even with platinum-based chemotherapy and the introduction of systemic immunotherapy, median overall survival is poor, and 5-year survival is only 15% [2].
The development of visceral metastases is well recognized as a poor prognostic factor in urothelial carcinoma [3]. Surgical resection of oligometastatic disease is an established option in the treatment of patients with other solid tumors [4], [5], [6] but little is known regarding the benefit or safety of metastasectomy for patients with urothelial carcinoma because previous studies were mostly from single institutions and limited by small sample size. To address this question, we conducted an observational study using the SEER-Medicare database to characterize the use of metastasectomy in urothelial carcinoma of the upper or lower urinary tract and to describe the associated clinical outcomes.
Section snippets
Data source and cohort
The data source was the linked SEER-Medicare database [7]. SEER is a National Cancer Institute (NCI)-sponsored consortium of population-based cancer registries that now cover almost 30% of Americans. For all incident cancers in their coverage areas, the SEER registries collect information regarding site and extent of disease, sociodemographic characteristics, and first course of cancer-directed therapy, with active follow-up for date and cause of death. Medicare is the primary health insurer
Results
We identified 497 patients meeting the defined inclusion criteria with at least 1 metastasectomy during a median follow-up of 40 months (interquartile range [IQR]: 20–68) from initial diagnosis, including 24 patients who had more than 1 metastasectomy resulting in a total of 523 metastasectomy procedures in the study. Baseline characteristics of patients are included in Table 1. Furthermore, 149/497 (30%) patients had previous primary surgery (99 cystectomies and 54 nephrouretrectomies). Most
Discussion
Systemic therapy remains the mainstay of treatment for metastatic urothelial carcinoma [1], [10], [11]. Although initial response rates to platinum-based chemotherapy are high, complete responses and cures are rarely achieved, and ultimately most patients die of metastatic disease, even with the recent introduction of checkpoint inhibitor immunotherapy [10].
Small single-institution studies from several centers in the United States, Europe, and Japan suggest that a subgroup of patients with
Acknowledgments
This work was supported by: NIH/NCATS Grant # KL2TR000458 (B.M.F.)
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2022, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :The median OS for their patient group was 19 months (95% CI: 15–23) after metastasectomy and over a third of patients were alive at 3 years. Patients who had metastasectomy for lymph node metastasis had the longest OS (median OS: 22 months), while bone resection had the worst prognosis (median OS: 9 months).[25] Despite the poor prognosis even with systemic therapy, a small group of patients seemed to survive more than 5 years, reflecting the heterogeneity of tumor biology and sensitivity to systemic therapy.[26]
Central Nervous System Metastasis in Patients With Urothelial Carcinoma: Institutional Experience and a Comprehensive Review of the Literature
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