Clinical features and prognostic indicators in upper-tract urothelial carcinoma with bone metastasis

Abstract

PurposeWith the gradual increase in the incidence of upper-tract urothelial carcinoma (UTUC), its metastatic disease has attracted much attention. The prognosis of UTUC patients with bone metastasis is worse than that of UTUC patients with other metastases. Therefore, the current study is performed to analyze the clinicopathologic features and survival predictors among UTUC patients with bone metastasis.Patients and methodsWe reviewed the Surveillance, Epidemiology, and End Results (SEER) database to select cases diagnosed with UTUC and bone metastasis at present from 2010 to 2016. Overall survival (OS) and cancer-specific survival (CSS) were first performed by applying univariate Cox regression analysis. Then we performed multivariate Cox analysis to determine independent predictors of survival. Forest plots were drawn by GraphPad 8.0.1 and used to visually display the results of multivariate analysis. Kaplan-Meier method was applied to intuitively show the prognosis difference of each independent risk factor.ResultsWe finally identified 380 UTUC patients with bone metastasis for survival analysis, of which 230 males (60.5%) and 150 females (39.5%). The mean and median age at diagnosis were 71 and 72 years, respectively. Simultaneous lung metastasis (33.4%) and liver metastasis (31.1%) were more common in UTUC patients with bone metastasis. The 1-year OS and CSS rates of this research population were 23.8% and 26.6%, respectively. Multivariate Cox proportional hazards modeling controlling for surgery, chemotherapy, brain metastasis, liver metastasis, lung metastasis, and marital status, revealed that surgery, chemotherapy, no liver metastasis, no lung metastasis, and married status predicted for better OS and CSS.ConclusionSurgery and chemotherapy are optimal management of UTUC patients with bone metastasis. Active treatments on lung and liver metastases should be performed. The prognosis of patients with unmarried status or others should be further improved.

Establishment and validation of a nomogram for predicting overall survival of upper-tract urothelial carcinoma with bone metastasis: a population-based study

“…Liu et al suggested that the prognosis of stage IV metastatic uroepithelial carcinoma depends on the number of metastases from other organs, with no difference in OS compared to other metastatic sites when using bone metastasis as a reference [ 30 ]. Importantly, our findings contrast with those of Zhou et al [ 7 ], who reported that lung metastasis was identified as a risk factor for OS in UTUC patients with BM. This discrepancy could be attributed to the fact that their study did not further stratify cases based on the presence of multiple metastases.…”

“…Simultaneous metastases to other sites were common in UTUC patients with BM and significantly reduced their survival rates [ 7 , 29 ]. Liu et al suggested that the prognosis of stage IV metastatic uroepithelial carcinoma depends on the number of metastases from other organs, with no difference in OS compared to other metastatic sites when using bone metastasis as a reference [ 30 ].…”

“…It is plausible that the presence of metastasis in other regions along with lung metastasis contributes to a poorer OS, rather than lung metastasis alone being the sole causative factor. In addition, their study did not develop a nomogram to facilitate clinical decision-making [ 7 ]. Our research addresses these gaps and indicates that multi-organ metastases are independent risk factors.…”

“…However, there is a lack of research on the management of UTUC patients with BM. Recent studies suggest that surgery and chemotherapy are optimal approaches, but further investigation is necessary to validate these findings [ 7 ].…”

Urothelial Carcinoma With Bone Metastasis Mimicking Sciatica: A Common Neoplasm With an Uncommon Presentation

“…The patients should understand the long-term prognosis and treatment options available [9]. These patients demand special attention as bone metastasis has a less favorable prognosis as compared to other metastatic sites [10] and also due to the high rate of skeletal-related events like severe spinal instability, intractable pain, and poor life quality, which is a big factor in restricting the application of chemotherapy [2]. Non-operative treatment is advised when tumor involvement has not led to spinal instability, neurological involvement, or intractable pain unresponsive to medical management and includes radiotherapy, chemotherapy, hormonal therapy, and high-dose steroid therapy.…”