BACKGROUND: Recent publications suggest a benefit from surgical removal of urothelial carcinoma metastases (UCM) for a subgroup of patients. OBJECTIVE: We report the combined experience and outcome of patients undergoing resection of UCM gained at 15 uro-oncologic centers in Germany. DESIGN, SETTING, AND PARTICIPANTS: Retrospective survey of 44 patients with distant UCM of the bladder or upper urinary tract who underwent complete resection of all detectable metastases in 15 different German uro-oncological centers between 1991 and 2008. INTERVENTION: Resected metastatic sites were the following: retroperitoneal lymph nodes (56.8%), distant lymph nodes (11.3%), lung (18.2%), bone (4.5%), adrenal gland (2.3%), brain (2.3%), small intestine (2.3%), and skin (2.3%). Systemic chemotherapy was administered in 35 of 44 patients (79.5%) before and/or after UCM surgery. MEASUREMENTS: Overall, cancer-specific and progression-free survival from time of diagnosis and metastasectomy of UCM. RESULTS AND LIMITATIONS: Median survival from initial diagnosis of UCM and subsequent resection was as follows: overall survival, 35 mo and 27 mo; cancer-specific survival, 38 mo and 34 mo; and progression-free survival, 19 mo and 15 mo. Overall 5-yr survival from metastasectomy for the entire cohort was 28%. Seventeen patients were still alive without progression at a median follow-up of 8 mo. Seven patients without disease progression survived for >2 yr and remained free from tumor progression at a median follow-up of 63 mo. No significant prognostic factors could be determined due to the limited patient number. CONCLUSIONS: Long-term cancer control and possible cure can be achieved in a subgroup of patients following surgical removal of UCM. Metastasectomy in patients with disseminated UCM remains investigational and should only be offered to those with limited disease as a combined-modality approach with systemic chemotherapy.
BACKGROUND: Recent publications suggest a benefit from surgical removal of urothelial carcinoma metastases (UCM) for a subgroup of patients. OBJECTIVE: We report the combined experience and outcome of patients undergoing resection of UCM gained at 15 uro-oncologic centers in Germany. DESIGN, SETTING, AND PARTICIPANTS: Retrospective survey of 44 patients with distant UCM of the bladder or upper urinary tract who underwent complete resection of all detectable metastases in 15 different German uro-oncological centers between 1991 and 2008. INTERVENTION: Resected metastatic sites were the following: retroperitoneal lymph nodes (56.8%), distant lymph nodes (11.3%), lung (18.2%), bone (4.5%), adrenal gland (2.3%), brain (2.3%), small intestine (2.3%), and skin (2.3%). Systemic chemotherapy was administered in 35 of 44 patients (79.5%) before and/or after UCM surgery. MEASUREMENTS: Overall, cancer-specific and progression-free survival from time of diagnosis and metastasectomy of UCM. RESULTS AND LIMITATIONS: Median survival from initial diagnosis of UCM and subsequent resection was as follows: overall survival, 35 mo and 27 mo; cancer-specific survival, 38 mo and 34 mo; and progression-free survival, 19 mo and 15 mo. Overall 5-yr survival from metastasectomy for the entire cohort was 28%. Seventeen patients were still alive without progression at a median follow-up of 8 mo. Seven patients without disease progression survived for >2 yr and remained free from tumor progression at a median follow-up of 63 mo. No significant prognostic factors could be determined due to the limited patient number. CONCLUSIONS: Long-term cancer control and possible cure can be achieved in a subgroup of patients following surgical removal of UCM. Metastasectomy in patients with disseminated UCM remains investigational and should only be offered to those with limited disease as a combined-modality approach with systemic chemotherapy.
Authors: Andrea Necchi; Luigi Mariani; Salvatore Lo Vullo; Evan Y Yu; Michael E Woods; Yu-Ning Wong; Lauren C Harshman; Ajjaj Alva; Cora N Sternberg; Aristotelis Bamias; Petros Grivas; Vadim S Koshkin; Florian Roghmann; Jakub Dobruch; Bernie J Eigl; Lucia Nappi; Matthew I Milowsky; Guenter Niegisch; Sumanta K Pal; Ugo De Giorgi; Federica Recine; Ulka Vaishampayan; Dominik D Berthold; Daniel W Bowles; Jack Baniel; Christine Theodore; Sylvain Ladoire; Sandy Srinivas; Neeraj Agarwal; Simon Crabb; Srikala Sridhar; Ali-Reza Golshayan; Carsten Ohlmann; Evanguelos Xylinas; Thomas Powles; Johnathan E Rosenberg; Joaquim Bellmunt; Bas van Rhijn; Matthew D Galsky; Kees Hendricksen Journal: Eur Urol Focus Date: 2017-06-03
Authors: Axel Heidenreich; Stefan Wilop; Michael Pinkawa; Daniel Porres; David Pfister Journal: Dtsch Arztebl Int Date: 2012-09-28 Impact factor: 5.594
Authors: J Lehmann; H Suttmann; P Albers; B Volkmer; J E Gschwend; G Fechner; M Spahn; A Heidenreich; A Odenthal; C Seif; N Nürnberg; C Wülfing; C Greb; T Kälble; M-O Grimm; C F Fieseler; S Krege; M Retz; H Schulte-Baukloh; M Gerber; M Hack; J Kamradt; M Stöckle Journal: Urologe A Date: 2009-02 Impact factor: 0.639