Can urologists introduce the concept of “oligometastasis” for metastatic bladder cancer after total cystectomy?

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.

Effects of oral maintenance chemotherapy and predictive value of circulating EBV DNA in metastatic nasopharyngeal carcinoma

“…In our study, patients with oligometastasis had better outcomes than those of patients with multiple metastases (83.5% vs 52.5%, P < .001). In many kinds of cancers, oligometastasis is an independent prognostic factor, including NPC . Some studies have shown that after systemic therapy, patients with oligometastasis can reach more than 5 years of progress‐free survival .…”

Radiotherapy for the treatment of distant nodes metastases from oligometastatic urothelial cancer: A retrospective case series

“…Patients from our single‐institution center with oligometastatic urothelial carcinoma from January 2013 to December 2016 were screened. Oligometastatic urothelial carcinoma was defined by three or fewer metastatic lesions and no liver metastases, similarly to the classification proposed by Ogihara et al . Among 41 advanced urothelial patients admitted to our department over the period, we identified seven (17%) patients who underwent SBRT for metastatic node lesions with the aim of either to consolidate the response to a previous systemic treatment or to delay the beginning of systemic chemotherapy.…”

“…It is known that metastatic disease with node‐only involvement and good PS has a better prognosis compared with patients with visceral metastasis (bone, lung and liver) and/or poor PS . Furthermore, urothelial carcinoma with oligometastases (defined as a solitary metastatic organ; number of metastatic lesions of ≤3; the largest diameter of metastatic foci of ≤5 cm; no liver metastases) has a favorable prognosis compared with non‐oligometastatic disease …”

“…18 Furthermore, urothelial carcinoma with oligometastases (defined as a solitary metastatic organ; number of metastatic lesions of ≤3; the largest diameter of metastatic foci of ≤5 cm; no liver metastases) has a favorable prognosis compared with non-oligometastatic disease. 19 To date, no studies have been carried out to investigate the potential use of SBRT for the treatment of node lesions from oligometastatic urothelial carcinoma. Here, we reported outcomes of a series of urothelial cancer patients with distant LNs metastases treated with SBRT at the Radiotherapy Unit of the University Hospital of Parma, Parma, Italy.…”

Metastasis-directed therapy for oligometastatic urological tumours: still no second-hand news

“…Despite the bad prognosis of metastatic UC (mUC), a subgroup of patients lives longer than 5 years after diagnosis. This subgroup consists of oligometastatic patients presenting with ≤3 metastatic lesions in a single organ (but no liver), and with the largest diameter of metastatic foci of ≤ 5 cm [66]. The critical question remains the definition of the imaging tool to optimise the finding of oligometastatic disease.…”