Year: 2018
Type: article
Study design: Observational Study
Abstract: You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2018PD41-05 THE ROLE OF METASTATIC BURDEN IN CYTOREDUCTIVE/CONSOLIDATIVE RADICAL CYSTECTOMY Roger Li, Janet Kukreja, Firas Petros, Matthew Campbell, Justin Nguyen, Graciela Nogueras Gonzalez, Ashish Kamat, Louis Pisters, Colin Dinney, and Neema Navai Roger LiRoger Li More articles by this author , Janet KukrejaJanet Kukreja More articles by this author , Firas PetrosFiras Petros More articles by this author , Matthew CampbellMatthew Campbell More articles by this author , Justin NguyenJustin Nguyen More articles by this author , Graciela Nogueras GonzalezGraciela Nogueras Gonzalez More articles by this author , Ashish KamatAshish Kamat More articles by this author , Louis PistersLouis Pisters More articles by this author , Colin DinneyColin Dinney More articles by this author , and Neema NavaiNeema Navai More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1944AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The strategy of surgical extirpation of the primary tumor in the setting of metastatic disease has gained acceptance for a variety of solid tumors. The role of cytoreductive/consolidative radical cystectomy (CCRC) for metastatic urothelial cancer (UC) is unknown. In this study, we describe our institutional experience with CCRC for metastatic UC and to investigate clinicopathologic features predicting prolonged cancer specific survival (CSS) following CCRC. METHODS We performed IRB approved review of our bladder cancer database, and identified 32 patients with metastatic cancer originating from the lower urinary tract who underwent CCRC. Of these, two patients had non-UC histology. Baseline demographics, regimen of chemotherapy, clinicopathologic features, and perioperative complications were collected. Progression free survival (PFS) and cancer specific survival (CSS) were estimated from the time of CCRC. Univariate and multivariate Cox regression models were used to identify predictors of improved CSS after CCRC. RESULTS Of the 32 patients, 19 (59%) had clinical evidence of distant metastases, while 13 were found to harbor occult metastases on the surgical specimen. The most common site of metastasis was the retroperitoneal lymph nodes, found in 17 patients. Solitary metastases were found in 19 patients (59%). Twenty-eight (88%) patients received chemotherapy prior to CCRC. Disease progression was detected in 29 patients after CCRC (median PFS 4.5 mo), while 28 died of metastatic cancer (median CSS 11.7 mo). On multivariate analysis, patients with solitary metastases were found to have improved CSS compared to those with multiple metastases (HR 2.51, 95% CI 1.06-5.92, p=0.04), with median CSS of 16.9 mo vs. 5.6 mo (p=0.003) (Fig. 1). Median postoperative LOS was 10 days. Overall, 59% suffered postoperative complications, including one perioperative mortality. CONCLUSIONS CCRC is feasible in the setting of metastatic UC, with comparable perioperative morbidity and mortality to RC with curative intent. Patients with solitary metastasis demonstrated longer CSS than those with multiple metastases, and should be considered candidates for future trials evaluating the role of CCRC for metastatic UC. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e810-e811 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Roger Li More articles by this author Janet Kukreja More articles by this author Firas Petros More articles by this author Matthew Campbell More articles by this author Justin Nguyen More articles by this author Graciela Nogueras Gonzalez More articles by this author Ashish Kamat More articles by this author Louis Pisters More articles by this author Colin Dinney More articles by this author Neema Navai More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Source: The Journal of Urology
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2795424255