Is There a Role for Pulmonary Metastasectomy With a Curative Intent in Patients With Metastatic Urinary Transitional Cell Carcinoma?

doi:10.1016/j.athoracsur.2011.03.097

The Annals of Thoracic Surgery

Volume 92, Issue 2, August 2011, Pages 449-453

https://doi.org/10.1016/j.athoracsur.2011.03.097 Get rights and content

Background

Systemic chemotherapy remains the standard treatment for metastatic transitional cell carcinoma (TCC) of the urinary tract. For pulmonary metastases of several malignancies, surgical therapy for selected patients has become a treatment of choice to achieve cure. However, data on pulmonary metastasectomy for urinary TCC remain limited.

Methods

From 1990 to 2005, 2,288 patients who underwent pulmonary metastasectomy for all types of malignancy were registered in the Metastatic Lung Tumor Study Group of Japan. Of these, we extracted 32 patients with TCC who underwent pulmonary metastasectomy with a curative intent from the database. We investigated the surgical outcomes of the patients, focusing on long-term progression-free survival (PFS) and modified PFS as a parameter for achieving a cure. In modified PFS, when the disease-free status had continued for longer than two years after repeated resection at the last follow-up, the first recurrence was not considered as an event.

Results

The five-year overall survival and PFS rates were 50% and 26%, respectively. Including 3 patients who underwent a second pulmonary metastasectomy for recurrence, 9 patients survived without recurrence for more than 5 years, resulting in a modified five-year PFS rate of 40%. Multivariate analysis revealed that a pulmonary metastasis greater than 3 cm was a significantly poor prognostic factor. The modified five-year PFS rate for patients with a pulmonary metastasis smaller than 3 cm in diameter was 65%.

Conclusions

Pulmonary metastasectomy may have a curative role in the treatment of metastatic TCC in appropriately selected patients, especially those with a small solitary pulmonary metastasis.

Section snippets

Material and Methods

From January 1990 to December 2005, 2,288 cases of pulmonary metastasectomy with curative intent were registered with the Metastatic Lung Tumor Study Group of Japan. We extracted 34 cases of TCC from the database. Two cases were excluded from analysis because of incomplete data. Finally, we analyzed 32 cases. The Tochigi Cancer Center Institutional Review Board approved this study, and waived the requirement of patient consent.

Clinical and pathological data included the following: patient age,

Results

Patient characteristics are shown in Table 1. The majority of the patients had solitary pulmonary metastasis (81%). Lobectomy was performed in 15 patients and limited resection in 17 patients. The primary reason for applying lobectomy was a large tumor size. The other reasons included a central location and misdiagnosis as primary lung cancer. Perioperative systemic chemotherapy was applied in 16 patients. The second pulmonary metastasectomy was conducted in 3 patients. The surgical procedures

Comment

Pulmonary metastasectomy has become a standard treatment for selected patients with several malignancies, including colorectal and renal cell carcinoma. However, pulmonary metastasectomy for patients with TCC is still controversial. The first case of pulmonary metastasectomy for TCC was reported by Orteza and colleagues in 1971 [6]. The patient was reported to have survived for more than five years. Thereafter, Cowles and colleagues [7] reported a median survival of five years in 6 patients

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To conduct a systematic review to assist a European consensus group in producing a definition of OMBC and to provide recommendations on staging and local therapies.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. Abstracts for articles focused on BC that addressed the issue of OMBC and provided a definition of oligometastatic status were selected. We collected data on the number of metastases, the number of metastases per organ, the number of organs involved, and metastatic sites that were excluded.
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There is little information on OMBC in the literature. Our systematic review revealed that only three to five metastatic sites amenable to surgery or radiotherapy that respond to systemic therapy is the setting most frequently chosen for a combination of systemic treatment and metastases-directed therapy. This setting could represent a basis for future prospective studies on OMBC.
Oligometastatic bladder cancer is a disease state in which favorable outcomes can be expected after a treatment combination of systemic therapy, plus surgery and/or radiotherapy for sites of bladder cancer metastasis. Our systematic review showed a lack of meaningful evidence to define this disease state. There is an urgent need to develop organized research in this field.
Pulmonary metastases in urogenital cancers: Surgical treatment and outcomes
2023, Cirugia Espanola
Metastasis is remaining one of the major problems in cancer treatment. Like many other malignancies, urogenital tumors originating from kidney, prostate, testes, and bladder tend to metastasize to the lungs.
The aim of this retrospective study is to evaluate the operative results and prognosis of pulmonary metastasectomy in patients with primary urogenital tumors.
This study was approved by the local ethical committee. We retrospectively analyzed the surgical and oncological results of patients who underwent lung resections for urogenital cancer metastases in our department between 2002 and 2018. Demographic data and clinicopathological features were extracted from the medical records. Survival outcomes according to cancer subtypes and early postoperative results of VATS and thoracotomy were analyzed.
22 out of 126 patients referred for pulmonary metastasectomy to our department had metastases from urogenital tumors. These patients consisted of 17 males and five females. Their metastasis originated from renal cell carcinoma (RCC; n = 9), bladder tumor (n = 7), testis tumors (n = 4), and prostate cancer (n = 2). There was no intraoperative complication. Postoperative complications were seen in 2 patients.
Although pulmonary metastasectomy in various types of tumors is well known and documented, the data is limited for metastases of urogenital cancers in the literature. Despite the limitations of this study, we aim to document our promising results of pulmonary metastasectomy in patients with primary urogenital tumors and wanted to emphasize the role of minimally invasive approaches.
La metástasis continua siendo uno de los principales problemas en el tratamiento del cáncer. Como muchas otras neoplasias malignas, los tumores urogenitales que se originan en el riñón, la próstata, los testículos y la vejiga tienden a hacer metástasis a los pulmones.
El objetivo de este estudio retrospectivo es evaluar los resultados quirúrgicos y el pronóstico de la metastasectomía pulmonar en pacientes con tumores urogenitales primarios.
Este estudio fue aprobado por el comité de ética local. Analizamos retrospectivamente los resultados quirúrgicos y oncológicos de los pacientes que fueron sometidos a resecciones pulmonares por metástasis de cáncer urogenital en nuestro servicio entre 2002 y 2018. Se extrajeron datos demográficos y características clínico-patológicas de las historias clínicas. Se analizaron los resultados de supervivencia según los subtipos de cáncer y los resultados postoperatorios tempranos de VATS y toracotomía.
Veintidós de 126 pacientes remitidos para metastasectomía pulmonar a nuestro servicio tenían metástasis de tumores urogenitales. Estos pacientes consistieron en 17 varones y 5 mujeres. Su metástasis se originó a partir de carcinoma de células renales (CCR; n = 9), tumor de vejiga (n = 7), tumores de testículo (n = 4) y cáncer de próstata (n = 2). No hubo ninguna complicación intraoperatoria. Se observaron complicaciones posoperatorias en 2 pacientes.
Aunque la metastasectomía pulmonar en varios tipos de tumores es bien conocida y documentada, los datos son limitados para las metástasis de cánceres urogenitales en la literatura. A pesar de las limitaciones de este estudio, nuestro objetivo es documentar nuestros prometedores resultados de la metastasectomía pulmonar en pacientes con tumores urogenitales primarios y queríamos enfatizar el papel de los enfoques mínimamente invasivos.
Utilization and outcomes of metastasectomy for patients with metastatic urothelial cancer: An analysis of the national cancer database
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Citation Excerpt :
One showed improved survival with solitary lung or solitary lymph node metastasis compared to other metastatic locations (81 vs 19 months).[14] Other studies, focused on reporting exclusively pulmonary metastasectomy for mUC, reported 5-year OS rates between 47%–50%.[13,16,23] A small series of 11 patients with biopsy-proven retroperitoneal mUC underwent retroperitoneal lymph node dissection after systemic chemotherapy with a reported 4-year cancer-specific survival rate of 27%.[24]
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We queried the NCDB from 2004 to 2016 for patients with metastatic urothelial carcinoma who had undergone metastasectomy. The annual utilization trend of metastasectomy was evaluated by linear regression. We compared overall survival (OS) between propensity score matched patients who had undergone metastasectomy and those who had not using two-sided log-rank and Cox regression models. We also performed sensitivity analyses on subcohorts of mUC.
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Citation Excerpt :
After chemotherapy completion, the net benefit obtained from postchemotherapy surgery is hardly evaluable, owing to limited available data. In fact, data exist mostly from few small, retrospective, usually single-center, experiences, with just a few larger analyses [2–15]. All these studies ultimately resulted in similar findings, that is, significant survival improvement can be obtained in selected patients, in particular when cisplatin-based chemotherapy can be administered, and objective response to chemotherapy is obtained.
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Original articleGeneral thoracicIs There a Role for Pulmonary Metastasectomy With a Curative Intent in Patients With Metastatic Urinary Transitional Cell Carcinoma?

Background

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

Surg Clin North Am

Ann Thorac Surg

J Urol

Urology

Ann Thorac Surg

J Urol

Eur Urol

Original article
General thoracic
Is There a Role for Pulmonary Metastasectomy With a Curative Intent in Patients With Metastatic Urinary Transitional Cell Carcinoma?