Commentary on Surgery for metastatic urothelial carcinoma with curative intent: The German experience (AUO AB 30/05)

Abstract

Recent publications suggest a benefit from surgical removal of urothelial carcinoma metastases (UCM) for a subgroup of patients. We report the combined experience and outcome of patients undergoing resection of UCM gained at 15 uro-oncologic centers in Germany on a retrospective survey of 44 patients with distant UCM of the bladder or upper urinary tract who underwent complete resection of all detectable metastases in 15 different German uro-oncological centers between 1991 and 2008. Resected metastatic sites were the following: retroperitoneal lymph nodes (56.8%), distant lymph nodes (11.3%), lung (18.2%), bone (4.5%), adrenal gland (2.3%), brain (2.3%), small intestine (2.3%), and skin (2.3%). Systemic chemotherapy was administered in 35 of 44 patients (79.5%) before and/or after UCM surgery. Overall, cancer-specific and progression-free survival from time of diagnosis and metastasectomy of UCM. Median survival from initial diagnosis of UCM and subsequent resection was as follows: overall survival, 35 and 27 months; cancer-specific survival, 38 and 34 months, and progression-free survival, 19 and 15 months. Overall 5-year survival from metastasectomy for the entire cohort was 28%. Seventeen patients were still alive without progression at a median follow-up of 8 months. Seven patients without disease progression survived for more than 2 years and remained free from tumor progression at a median follow-up of 63 months. No significant prognostic factors could be determined due to the limited patient number. Long-term cancer control and possible cure can be achieved in a subgroup of patients following surgical removal of UCM. Metastasectomy in patients with disseminated UCM remains investigational and should only be offered to those with limited disease as a combined-modality approach with systemic chemotherapy.