The role of surgery on the primary tumor site in bladder cancer with distant metastasis: significance of histology type and metastatic pattern

Wang, Ping; Zang, Shuang; Li, Guangqi; Qu, Wei-ling; Li, Shuyao; Qiao, Qiao; Jiang, Yufei

doi:10.1002/cam4.3560

Cited by 20 publications

(15 citation statements)

References 23 publications

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“…In our stable visualized nomogram, histology, differentiation, chemotherapy, T stage, and age were primary predictive variables that could estimate whether an mBC patient could benefit from the removal of the primary tumor. Our research is in line with the recent study that histology type is an independent prognostic factor for OS ( 22 ). According to our study, patients with non-urothelial carcinoma have a greater chance of benefiting from PTR.…”

Section: Discussionsupporting

confidence: 92%

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A Model for Identifying Optimal Patients for Primary Tumor Resection in Patients With Metastatic Bladder Cancer

Zheng

et al. 2022

Front. Oncol.

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BackgroundA survival benefit was observed in metastatic bladder cancer patients who underwent primary tumor resection, but it was still confusing which patients are suitable for the surgery. For this purpose, we developed a model to screen stage M1 patients who would benefit from primary tumor resection.MethodsPatients with metastatic bladder cancer were screened from the Surveillance, Epidemiology, and End Results database (2004–2016) and then were divided into surgery (partial or complete cystectomy) group and non-surgery group. To balance the characteristics between them, a 1:1 propensity score matching analysis was applied. A hypothesis was proposed that the received primary tumor resection group has a more optimistic prognosis than the other group. The multivariable Cox model was used to explore the independent factors of survival time in two groups (beneficial and non-beneficial groups). Logistic regression was used to build a nomogram based on the significant predictive factors. Finally, a variety of methods are used to evaluate our model.ResultsA total of 7,965 patients with metastatic bladder cancer were included. And 3,314 patients met filtering standards, of which 545 (16.4%) received partial or complete cystectomy. Plots of the Kaplan–Meier and subgroup analyses confirmed our hypothesis. After propensity score matching analysis, a survival benefit was still observed that the surgery group has a longer median overall survival time (11.0 vs. 6.0 months, p < 0.001). Among the surgery cohort, 303 (65.8%) patients lived longer than 6 months (beneficial group). Differentiated characteristics included age, gender, TNM stage, histologic type, differentiation grade, and therapy, which were integrated as predictors to build a nomogram. The nomogram showed good discrimination in both training and validation cohorts (area under the receiver operating characteristic curve (AUC): 0.806 and 0.742, respectively), and the calibration curves demonstrated good consistency. Decision curve analysis showed that the nomogram was clinically useful. Compared with TNM staging, our model shows a better predictive value in identifying optimal patients for primary tumor resection.ConclusionsA practical predictive model was created and verified, which might be used to identify the optimal candidates for the partial or complete cystectomy group of the primary tumor among metastatic bladder cancer.

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Section: Discussionsupporting

confidence: 92%

“…For mBC undergoing chemotherapy, PTR still can prolong survival time. Similar to this finding, a study confirmed that both surgery and chemotherapy are independent prognostic risk factors ( 22 ). The PTR combined with multimodality therapy could prolong survival time ( 24 ).…”

Section: Discussionsupporting

confidence: 79%

A Model for Identifying Optimal Patients for Primary Tumor Resection in Patients With Metastatic Bladder Cancer

Zheng

et al. 2022

Front. Oncol.

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“…The development of skeletal disease is associated with impaired QoL because of severe complications such as pain, pathological fractures, nerve root or spinal cord or compression, reduced mobility, and hypercalcemia (43). Since the pathophysiology and formation mechanism of bone metastases is rather complex, involving several events at the primary site as well as the metastatic sites, a multidisciplinary approach is needed to manage metastatic skeletal disease, including treatment modalities such as surgery, chemotherapy, RT, bisphosphonates, and radioisotopes (44)(45)(46).…”

Section: Radiotherapy For Bone Metastasesmentioning

confidence: 99%

Radiotherapy in Metastatic Urothelial Carcinoma: Rationale and Clinical Applications

et al. 2022

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Urothelial carcinoma is the most common type of bladder cancer including upper urinary tract urothelial cell carcinoma (renal pelvis and ureters) and urethral carcinoma. It exhibits high mortality and morbidity rates and is usually diagnosed at a late, incurable stage, carrying a poor prognosis. Local symptoms in patients with metastatic urothelial carcinoma (mUC) have an adverse impact on quality of life (QoL) and are associated with frequent hospitalizations. Herein, we review the role of palliative radiotherapy in mUC as the means to ameliorate a wide range of symptoms, seeking optimum patient stratification, even though the latter should be balanced against any acute or late toxicity that may arise. For this, links to the molecular biology of mUC are explored and QoL assessments are presented. To maximize patient benefit from radiotherapy, we conclude that multi-modal datasets need to be re-visited to better inform multi-center studies where policy makers, health professionals, researchers, and patient groups meet. Radiotherapy either as a monotherapy or alongside systemic therapy may serve as an added value.Urothelial carcinoma (UC) is considered as the most common tumor type that arises from the urinary tract and may present either as bladder carcinoma (BC), upper urinary tract urothelial cell carcinoma (UTUC), or urethral carcinoma (1). BC has been reported as the 10th most common cancer worldwide in 2020 and the 6th most common tumor type in the USA, occurring mainly in older people, with a median age at diagnosis of 73 years (2-4). In developed countries, UTUC shows a lower incidence than that of BC and the ratio of the UC incidence in the renal pelvis, ureter, and bladder is approximately 3: 1: 51 (5, 6). About 25% of patients with UC present with metastatic disease. The 5-year survival for this group of patients is only 7.7% (SEER statistics; 2, 3, 7, 8).Systemic therapy remains the cornerstone in the management of patients with mUC. Prior to the development of effective chemotherapy, median survival for mUC patients rarely exceeded 3 to 6 months (9). In the last few years, a revolution was witnessed in this field, with platinum-based chemotherapy, therapy with checkpoint inhibitors, and more recently immunotherapy, all giving promising results (10). Although the role of radiotherapy is limited in the management of mUC patients in the context of improving survival, its addition to our therapeutic toolbox offers considerable symptomatic relief especially in patients with hematuria and bone metastases (11, 12).Our aim was to feature the role of radiotherapy (RT) in mUC, emphasizing the new RT techniques available and offer guidelines on how to apply this treatment modality in different clinical scenarios. To this end, the underlying molecular enigmas and quality of life (QoL) endpoints cannot be overlooked. To maximize patient benefit from RT, either as a monotherapy or alongside systemic therapy, we conclude that multi modal datasets need to be re-visited to better inform multicenter studies where polic...

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“…Surgical resection of the primary tumor is a crucial component of the complex remedy of many metastatic tumors [ 23 , 24 ]. Nevertheless, only a few researches have assessed the impact of surgery on survival outcomes in bladder cancer with organ metastasis [ 25 , 26 ]. Moreover, only a few researches have evaluated the impact of surgery on survival outcomes of UBUC patients with organ metastasis.…”

Section: Discussionmentioning

confidence: 99%

Effects of Different Organ Metastases on the Prognosis of Stage IV Urothelial Carcinoma of the Bladder

Liu

Yuan

Wang

et al. 2022

Journal of Oncology

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Objective. To assess the prognosis of stage IV metastatic urinary bladder urothelial carcinoma (UBUC) at initial diagnosis and determine prognostic factors based on distant organ metastasis. Methods. A retrospective cohort analysis of UBUC was conducted based on the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression analyses were used to determine the variables associated with overall survival (OS). Kaplan–Meier curves were used to compare survival curves among different groups. Results. A total of 3103 patients with stage IV UBUC were selected for analysis. The number of distant organ metastatic sites independently predicted the OS. The OS was not different in other metastatic sites when bone metastasis was used as a reference P > 0.05 . However, the OS was shorter for a single metastatic site P < 0.001 and multiple metastatic sites when metastasis was not used as a reference P < 0.001 . Multivariable Cox regression analysis indicated that low survivorship was independently associated with no surgery for the entire cohort and patients with only one metastatic organ. Sex (P = 0.019) and grade (P = 0.046) were the independent risk factors for patients with only one metastatic organ. Conclusions These results show that the prognosis of stage IV metastatic UBUC is not different between any single metastatic organ. The prognosis of stage IV metastatic UBUC depends on the number of distant organ metastasis. This study determined some predictors of survival and thus may help therapists to choose appropriate treatment strategies for metastatic UBUC.

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The role of surgery on the primary tumor site in bladder cancer with distant metastasis: significance of histology type and metastatic pattern

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 20 publications

References 23 publications

A Model for Identifying Optimal Patients for Primary Tumor Resection in Patients With Metastatic Bladder Cancer

A Model for Identifying Optimal Patients for Primary Tumor Resection in Patients With Metastatic Bladder Cancer

Radiotherapy in Metastatic Urothelial Carcinoma: Rationale and Clinical Applications

Effects of Different Organ Metastases on the Prognosis of Stage IV Urothelial Carcinoma of the Bladder

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