Abstract
We investigated whether the concept of oligometastasis may be introduced to the clinical management of metastatic bladder cancer patients. Our study population comprised 128 patients diagnosed with metastatic bladder cancer after total cystectomy at our 6 institutions between 2004 and 2014. We extracted independent predictors for identifying a favorable. Occurrence that fulfilled all 4 criteria which were independently associated with cancer-specific death was defined as oligometastasis: a solitary metastatic organ; number of metastatic lesions of 3 or less; the largest diameter of metastatic foci of 5cm or less; and no liver metastasis. We evaluated differences in clinical outcomes between patients with oligometastasis (oligometastasis group) and those without oligometastasis (non-oligometastasis group). Overall, there were 43 patients in the oligometastasis group. The 2-year cancer-specific survival rate in the oligometastasis group was 53.3%, which was significantly higher than that in the non-oligometastasis group (16.1%, p<0.001). A multivariate analysis revealed that non-oligometastasis (p<0.001), not performing salvage chemotherapy (p<0.001), and not performing metastatectomy (p=0.028) were independent risk factors for cancer-specific death. In the subgroup of 83 patients who received salvage chemotherapy, 30 were in the oligometastasis group. The 2-year cancer-specific survival rate in the oligometastasis group was 55.0%, which was significantly higher than that in the non-oligometastasis group (22.0%, p=0.005). Non-oligometastasis (p=0.009) was the only independent risk factor for cancer-specific death. We presented that urothelial carcinoma with oligometastasis had a favorable prognosis and responded to systemic chemotherapy. Oligometastasis may be treated as a separate entity in the field of metastatic urothelial carcinoma.
Highlights
Among various types of malignant tumors, the prognosis of metastatic bladder cancer (BC) is known to be poor, and its treatment mainly involves systemic chemotherapy
We investigated whether the concept of oligometastasis may be introduced to the clinical management of metastatic bladder cancer patients
We evaluated differences in clinical outcomes between patients with oligometastasis and those without oligometastasis
Summary
Among various types of malignant tumors, the prognosis of metastatic bladder cancer (BC) is known to be poor, and its treatment mainly involves systemic chemotherapy. Cancer cells are sloughed out of the primary tumor and land at target organs. Since they do not have the properties necessary to survive the circulation and invade target organs, the prognosis of patients with oligometastasis appears to be good. Mertens et al have already suggested the concept of oligometastasis in BC [8] They mentioned that the optimal imaging modalities might be important for the definition of oligometastatic BC and further study evaluating detailed clinical features of defined oligometastasis in metastatic BC would be warranted.
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