Pulmonary Metastasectomy Could Prolong Overall Survival in Select Cases of Metastatic Urinary Tract Cancer

Abstract

BackgroundThe purpose of the study was to evaluate the efficacy of metastasectomy for urinary tract carcinoma (UTC) and to determine prognostic factors that affect survival. Patients and MethodsData from a total of 30 patients with metastatic UTC who underwent a metastasectomy between February 2000 and July 2014 were analyzed retrospectively. Time to disease progression (TTP) and overall survival (OS) from metastasectomy, and potential prognostic factors were evaluated. ResultsThe lung was the most frequent site of metastasectomy (n = 24) followed by the liver (n = 3) and lymph nodes (n = 3). With a median follow-up duration of 54.2 months, the median TTP was 15.2 months and the median OS was 30.0 months (95% confidence interval, 15.1-42.9) with a 3-year survival rate of 41%. In multivariate analysis, initial stage IV disease (P = .047), pure urothelial pathology (P = .034), and nonpulmonary metastasectomy (P = .040) were independent prognostic factors for a shorter TTP. Nonpulmonary metastasectomy was an independent factor affecting OS (P = .001). ConclusionA metastasectomy has the potential to contribute to better oncologic outcome in select patients with metastatic UTC, especially those with a single rather than multiple and pulmonary rather than nonpulmonary metastases due to recurrent rather than initially metastatic urinary tract cancer.