How do organ-specific metastases affect prognosis and surgical treatment for patients with metastatic upper tract urothelial carcinoma: first evidence from population based data
To evaluate the prognostic roles of organ-specific metastases and analyze the impact of organ-specific metastases on surgical resection of the primary tumor for metastatic upper tract urothelial carcinoma (UTUC) patients. A population-based study using Surveillance, Epidemiology, and End Results database was carried out. Kaplan–Meier analysis were used for survival comparisons. Multivariate Cox regression model was employed to analyze the effect of distant metastatic organs on overall survival (OS) and cancer specific survival (CSS). 337 patients from 2010 to 2014 were included. Patients with brain metastasis had significantly worse OS (p = 0.012) and CSS (p = 0.004). Liver metastasis could only independently predict unfavorable OS rather than CSS. Multivariate analysis showed that patients with bone, lung or distant lymph node metastasis was not independent prognostic factor for patients’ survival. Surgical resection of the primary tumor was an independent favorable predictor for both OS (p = 0.004) and CSS advantages (p = 0.006). In subgroup analysis, patients with multiple organs of metastasis or distant lymph node involvement could benefit from surgical resection of the primary tumor. However, the presence of liver or lung metastasis could make such surgery become meaningless from the point of survival benefits. Our study showed that brain metastasis independently predicted both unfavorable OS and CSS for metastatic UTUC patients while liver metastasis was only associated with worse OS. More importantly, surgical resection of the primary tumor might still lead to survival benefits for highly selected patients.
KeywordsMetastatic upper tract urothelial carcinoma Metastatic organ Surgical resection of the primary tumor Overall survival Cancer specific survival
Upper tract urothelial carcinoma
Surveillance, Epidemiology, and End Results
Cancer specific survival
This study was supported by the National Natural Science Foundation of China (Grant No. 81370753 to Qiang Ding; No. 81472379 to Zhoujun Shen and No. 81702507 to Tianyuan Xu), Zhejiang Provincial Natural Science Foundation of China (Grant No. LY16H160016 to Shanwen Chen) and the National Basic Research Program of China (973 Program) (Grant No. 2015CB943003 to Qiang Ding).
Compliance with ethical standards
Conflict of interest
The authors report no conflicts of interest in this work.
- 2.Tanaka N, Kikuchi E, Kanao K, Matsumoto K, Kobayashi H, Ide H, Miyazaki Y, Obata J, Hoshino K, Shirotake S, Akita H, Kosaka T, Miyajima A, Momma T, Nakagawa K, Hasegawa S, Nakajima Y, Jinzaki M, Oya M (2014) Metastatic behavior of upper tract urothelial carcinoma after radical nephroureterectomy: association with primary tumor location. Ann Surg Oncol 21(3):1038–1045. https://doi.org/10.1245/s10434-013-3349-z CrossRefPubMedGoogle Scholar
- 3.Oweira H, Petrausch U, Helbling D, Schmidt J, Mannhart M, Mehrabi A, Schob O, Giryes A, Decker M, Abdel-Rahman O (2017) Prognostic value of site-specific metastases in pancreatic adenocarcinoma: a Surveillance Epidemiology and End Results database analysis. World J Gastroenterol 23(10):1872–1880. https://doi.org/10.3748/wjg.v23.i10.1872 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Dong F, Shen Y, Gao F, Xu T, Wang X, Zhang X, Zhong S, Zhang M, Chen S, Shen Z (2017) Prognostic value of site-specific metastases and therapeutic roles of surgery for patients with metastatic bladder cancer: a population-based study. Cancer Manag Res 9:611–626. https://doi.org/10.2147/CMAR.S148856 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Roupret M, Babjuk M, Burger M, Comperat E, Cowan N (2017) Urothelial carcinoma of the upper urinary tract. In: EAU-ESTRO-ESUR-SIOG guidelines, 2017 edn. EAU Guidelines Office, Arnhem, pp 16–17Google Scholar
- 9.Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, Lotan Y, Weizer A, Raman JD, Wood CG, Upper Tract Urothelial Carcinoma Collaboration (2009) Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer 115(6):1224–1233. https://doi.org/10.1002/cncr.24135 CrossRefPubMedGoogle Scholar
- 10.Lughezzani G, Jeldres C, Isbarn H, Shariat SF, Sun M, Pharand D, Widmer H, Arjane P, Graefen M, Montorsi F, Perrotte P, Karakiewicz PI (2010) A critical appraisal of the value of lymph node dissection at nephroureterectomy for upper tract urothelial carcinoma. Urology 75(1):118–124. https://doi.org/10.1016/j.urology.2009.07.1296 CrossRefPubMedGoogle Scholar
- 11.Sevillano E, Werner L, Bosse D, Lalani AA, Wankowicz SAM, de Velasco G, Farina M, Lundgren K, Choueiri TK, del Alba AG, Bellmunt J (2017) Upper Tract Urothelial Carcinomas: prognostic factors and outcomes in patients with non-lymph node distant metastasis. Clin Genitourin Cancer. https://doi.org/10.1016/j.clgc.2017.07.012 PubMedGoogle Scholar
- 12.Gandaglia G, Karakiewicz PI, Briganti A, Passoni NM, Schiffmann J, Trudeau V, Graefen M, Montorsi F, Sun M (2015) Impact of the site of metastases on survival in patients with metastatic prostate cancer. Eur Urol 68(2):325–334. https://doi.org/10.1016/j.eururo.2014.07.020 CrossRefPubMedGoogle Scholar
- 13.Hsieh MC, Chiang PH, Rau KM, Chen YY, Su YL, Huang CH (2015) The comparison of oncologic outcomes between metastatic upper tract urothelial carcinoma and urothelial carcinoma of the bladder after cisplatin-based chemotherapy. Urol Oncol 33(11):495 e499–495 e414. https://doi.org/10.1016/j.urolonc.2015.07.001 .CrossRefGoogle Scholar
- 14.Nakagawa T, Hara T, Kawahara T, Ogata Y, Nakanishi H, Komiyama M, Arai E, Kanai Y, Fujimoto H (2013) Prognostic risk stratification of patients with urothelial carcinoma of the bladder with recurrence after radical cystectomy. J Urol 189(4):1275–1281. https://doi.org/10.1016/j.juro.2012.10.065 CrossRefPubMedGoogle Scholar
- 15.Bellmunt J, Choueiri TK, Fougeray R, Schutz FA, Salhi Y, Winquist E, Culine S, von der Maase H, Vaughn DJ, Rosenberg JE (2010) Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens. J Clin Oncol 28(11):1850–1855. https://doi.org/10.1200/JCO.2009.25.4599 CrossRefPubMedGoogle Scholar