Prognostic Significance of Organ-Specific Metastases in Patients with Metastatic Upper Tract Urothelial Carcinoma

Abstract

Background: Existing data on metastatic upper tract urothelial carcinoma (mUTUC) are limited. In this study, we investigated the prognostic value of site-specific metastases in patients with mUTUC and its association with survival outcomes. Methods: We retrospectively collected data from the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2016. Kaplan–Meier analysis with a log-rank test was used for survival comparisons. Multivariate Cox regression was employed to predict overall survival (OS) and cancer-specific survival (CSS). Results: 633 patients were selected in this study cohort. The median follow-up was 6 months (IQR 2–13) and a total of 584 (92.3%) deaths were recorded. Within the population presenting with a single metastatic organ site, the most common metastatic sites were distant lymph nodes, accounting for 36%, followed by lung, bone and liver metastases, accounting for 26%, 22.8% and 16.2%, respectively. In patients with a single metastatic organ site, the Kaplan–Meier curves showed significantly worse OS for patients with liver metastases vs. patients presenting with metastases in a distant lymph node (p < 0.001), bone (p = 0.023) or lung (p = 0.026). When analyzing CSS, statistically significant differences were detectable only between patients presenting with liver metastases vs. distant lymph node metastases (p < 0.001). Multivariate analyses showed that the presence of liver (OS: HR = 1.732, 95% CI = 1.234–2.430, p < 0.001; CSS: HR = 1.531, 95% CI = 1.062–2.207, p = 0.022) or multiple metastatic organ sites (OS: HR = 1.425, 95% CI = 1.159–1.753, p < 0.001; CSS: HR = 1.417, 95% CI = 1.141–1.760, p = 0.002) was an independent predictor of poor survival. Additionally, survival benefits were found in patients undergoing radical nephroureterectomy (RNU) (OS: HR = 0.675, 95% CI = 0.514–0.886, p = 0.005; CSS: HR = 0.671, 95% CI = 0.505–0.891, p = 0.006) and chemotherapy (CHT) (OS: HR = 0.405, 95% CI = 0.313–0.523, p < 0.001; CSS: HR = 0.435, 95% CI = 0.333–0.570, p < 0.001). Conclusions: A distant lymph node was the most common site of single-organ metastases for mUTUC. Patients with liver metastases and patients with multiple organ metastases exhibited worse survival outcomes. Lastly, CHT administration and RNU were revealed to be predictors of better survival outcomes in the mUTUC cohort.

The poor antitumor effect of pembrolizumab in advanced upper urothelial carcinoma with renal parenchymal invasion

“…The proportion of RPI invasion at the primary site in UTUC is not clear. Some studies have reported that the percentage of renal pelvis cancers in UTUC were around 65%, and 25–50% of UTUC cases were above T3 27–29 . The number of T3 cases in our UTUC cohort was quite large (48 cases; 75.0%), and the number of cases with RPI was also large (23 cases; 35.9%).…”

“…Some studies have reported that the percentage of renal pelvis cancers in UTUC were around 65%, and 25-50% of UTUC cases were above T3. [27][28][29] The number of T3 cases in our UTUC cohort was quite large (48 cases; 75.0%), and the number of cases with RPI was also large (23 cases; 35.9%). The high rate of RPI in our cohort was probably because many patients were referred to our hospital for differentiation from renal cancer.…”

Real-world retrospective review of monotherapy following platinum-based chemotherapy for metastatic urothelial cancer

“… 16 In a large retrospective study on metastatic upper UC, the most common site of metastasis was identified as the distant lymph nodes, and liver metastasis was found to be a poor prognostic factor, whereas primary tumour resection and chemotherapy were predictors of better survival outcome. 17 The development of cisplatin-based combination chemotherapy has extended median survival from several to 11–15 months. 16 However, the prognosis for metastatic patients with no response to primary chemotherapy is poor.…”

Higher Expression of Annexin A2 in Metastatic Bladder Urothelial Carcinoma Promotes Migration and Invasion

“…Bladder urothelial carcinoma is a highly heterogeneous disease with varying clinical outcomes. Patients with the same tumor stage may have different survival outcomes [ 2 , 3 , 4 , 5 , 42 ]. The survival rates correlate directly with the cancer cell proliferation, migration, and invasion of bladder cancer.…”