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Oncologic Outcome of Metastasectomy for Urothelial Carcinoma: Who Is the Best Candidate?

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Resection of metastatic lesions (metastasectomy) is performed for highly selected patients with metastatic urothelial carcinoma (mUC). This study aimed to identify the clinicopathologic factors associated with oncologic outcome for patients who underwent metastasectomy for mUC.

Methods

This analysis included 37 UC patients who underwent metastasectomy with curative intent at nine Japanese hospitals. The primary end point was cancer-specific survival. The Kaplan–Meier method with the log-rank test and the multivariable Cox proportional hazards model addressed the relationship between clinical characteristics and survival.

Results

Metastasectomy was performed for pulmonary (n = 23), nodal (n = 7), and other (n = 7) metastases. The median survival time was 35.4 months (interquartile range [IQR] 15.5, not reached) from the detection of metastasis and 34.3 months (IQR 13.1, not reached) from metastasectomy. The 5-year cancer-specific survival rate after detection of metastasis was 39.7%. In the multivariate analysis, the time from primary surgery to detection of metastasis (time-to-recurrence [TTR]) of 15 months or longer (hazard ratio [HR] 0.23; p = 0.0063), no symptoms of recurrence (HR 0.23; p = 0.0126), and serum C-reactive protein (CRP) levels lower than than 0.5 mg/dl (HR 0.24; p = 0.0052) were significantly associated with better survival.

Conclusions

Long-term survival could be achieved for some patients with mUC who underwent metastasectomy. Lung and lymph nodes were predominant sites for metastasectomy. Symptoms, TTR, and CRP value were identified as associated with survival and should be taken into account when metastasectomy is considered.

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Acknowledgment

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Disclosure

All authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Tohru Nakagawa MD, PhD, Satoru Taguchi MD, Atsushi Kanatani MD, PhD, Taketo Kawai MD, PhD, Akihiko Matsumoto MD, PhD, Hideyo Miyazaki MD, PhD, Tetsuya Fujimura MD, PhD, Hiroshi Fukuhara MD, PhD, Haruki Kume MD, PhD, Yasuhiko Igawa MD, PhD & Yukio Homma MD, PhD

  2. Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan

    Satoru Taguchi MD & Yutaka Enomoto MD, PhD

  3. Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan

    Satoru Taguchi MD, Jimpei Miyakawa MD & Motofumi Suzuki MD, PhD

  4. Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan

    Taketo Kawai MD, PhD & Yoshinori Tanaka MD, PhD

  5. Department of Urology, Toranomon Hospital, Tokyo, Japan

    Masaomi Ikeda MD, PhD, Shinji Urakami MD, PhD & Toshikazu Okaneya MD, PhD

  6. Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

    Akihiko Matsumoto MD, PhD & Yasushi Nagase MD

  7. Department of Urology, The Fraternity Memorial Hospital, Tokyo, Japan

    Yoshimitsu Komemushi MD, Hiroaki Nishimatsu MD, PhD & Yoshikazu Hirano MD, PhD

  8. Department of Urology, National Center for Global Health and Medicine Center Hospital, Tokyo, Japan

    Daisuke Yamada MD, PhD & Haruki Kume MD, PhD

  9. Department of Urology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

    Yasushi Kondo MD, PhD

Authors
  1. Tohru Nakagawa MD, PhD
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  2. Satoru Taguchi MD
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  3. Atsushi Kanatani MD, PhD
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  5. Masaomi Ikeda MD, PhD
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  6. Shinji Urakami MD, PhD
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  7. Akihiko Matsumoto MD, PhD
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  8. Yoshimitsu Komemushi MD
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  11. Motofumi Suzuki MD, PhD
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  12. Yutaka Enomoto MD, PhD
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  13. Hiroaki Nishimatsu MD, PhD
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  16. Yoshikazu Hirano MD, PhD
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  17. Toshikazu Okaneya MD, PhD
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  18. Yoshinori Tanaka MD, PhD
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  19. Hideyo Miyazaki MD, PhD
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  20. Tetsuya Fujimura MD, PhD
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  21. Hiroshi Fukuhara MD, PhD
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  22. Haruki Kume MD, PhD
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  23. Yasuhiko Igawa MD, PhD
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  24. Yukio Homma MD, PhD
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Corresponding author

Correspondence to Tohru Nakagawa MD, PhD.

Electronic supplementary material

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10434_2017_5970_MOESM1_ESM.tif

Supplementary Fig. 1 Cancer-specific survival according to the site of metastasectomy. Supplementary material 1 (TIFF 66 kb)

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Nakagawa, T., Taguchi, S., Kanatani, A. et al. Oncologic Outcome of Metastasectomy for Urothelial Carcinoma: Who Is the Best Candidate?. Ann Surg Oncol 24, 2794–2800 (2017). https://doi.org/10.1245/s10434-017-5970-8

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  • DOI: https://doi.org/10.1245/s10434-017-5970-8

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