Subscribe to RSS
Metastases of Urothelium Carcinoma: Differential Diagnosis, Resection, and SurvivalFunding None declared.
Background Due to its very aggressive nature and low survival chances, the metastasized urothelium carcinoma poses a challenge in regard to therapy. The gold-standard chemotherapy is platinum based. The therapy options are considered controversial, including new systemic therapies. In this respect, surgical therapies, as already established for pulmonary metastases of other tumor entities play an increasingly important role. The consumption of nicotine is a risk factor not only for urothelium carcinoma but also for a pulmonary carcinoma. Thus, we examined the frequency of a second carcinoma in this cohort.
Methods We retrospectively examined patients who had a differential diagnosis of pulmonary metastases, as well as those patients who underwent a surgery due to pulmonary metastases of a urothelium carcinoma between 1999 and 2015.
Results A total of 139 patients came to our clinic with the differential diagnosis of pulmonary metastases of a urothelium carcinoma. The most common diagnosis was pulmonary carcinoma (53%). Thirty-one patients underwent surgeries due to pulmonary metastases of a urothelium carcinoma. The median survival was 53 months and the 5-year survival was 51%. With the univariate analysis, only the relapse-free interval of more than 10 months was statistically significant (p < 0.001).
Conclusion There is a high coincidence of urothelial carcinoma and lung carcinoma. A histological confirmation should be endeavored. Selected patients undergoing a pulmonary metastasis resection have a survival advantage during the multimodal treatment of pulmonary metastasized urothelial carcinomas. For a definitive recommendation, randomized trials including a uniform multimodal therapy regimen and higher numbers of patients are necessary.
Received: 31 August 2020
Accepted: 05 February 2021
16 April 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Cancer stat facts: bladder cancer. 2017 . Accessed 3 Sep 2018 at: https://seer.cancer.gov/statfacts/html/urinb.html
- 2 Leitlinienreport der S3-Leitline zur Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinoms. 2016 . Accessed 12 Apr 2018 at: https://www.awmf.org/uploads/tx_szleitlinien/032-038ol_m_S3_Harnblasenkarzinom_2016-12.pdf
- 3 Powles T, Durán I, van der Heijden MS. et al. Atezolizumab versus chemotherapy in patients with platinum-treated locally advanced or metastatic urothelial carcinoma (IMvigor211): a multicentre, open-label, phase 3 randomised controlled trial. Lancet 2018; 391 (10122): 748-757
- 4 Cowles RS, Johnson DE, McMurtrey MJ. Long-term results following thoracotomy for metastatic bladder cancer. Urology 1982; 20 (04) 390-392
- 5 Vogt-Moykopf I, Krysa S, Bülzebruck H, Schirren J. Surgery for pulmonary metastases. The Heidelberg experience. Chest Surg Clin N Am 1994; 4 (01) 85-112
- 6 Cahan WG, Shah JP, Castro EB. Benign solitary lung lesions in patients with cancer. Ann Surg 1978; 187 (03) 241-244
- 7 Grantzau T, Mellemkjær L, Overgaard J. Second primary cancers after adjuvant radiotherapy in early breast cancer patients: a national population based study under the Danish Breast Cancer Cooperative Group (DBCG). Radiother Oncol 2013; 106 (01) 42-49
- 8 Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol 2017; 27 (01) 138-148
- 9 Sponholz S, Schirren M, Oguzhan S, Schirren J. Morbidity, mortality, and survival in elderly patients undergoing pulmonary metastasectomy for colorectal cancer. Int J Colorectal Dis 2018; 33 (10) 1401-1409
- 10 Rodríguez-Fuster A, Belda-Sanchis J, Aguiló R. et al; GECMP-CCR-SEPAR. Morbidity and mortality in a large series of surgical patients with pulmonary metastases of colorectal carcinoma: a prospective multicentre Spanish study (GECMP-CCR-SEPAR). Eur J Cardiothorac Surg 2014; 45 (04) 671-676
- 11 Miyazaki J, Nishiyama H, Fujimoto H. et al; Cancer Registration Committee of the Japanese Urological Association. Impact of smoking on the age at diagnosis of upper tract urothelial carcinoma: subanalysis of the Japanese Urological Association multi-institutional national database. Int J Urol 2015; 22 (11) 1023-1027
- 12 von der Maase H, Hansen SW, Roberts JT. et al. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 2000; 18 (17) 3068-3077
- 13 Sternberg CN, de Mulder P, Schornagel JH. et al; EORTC Genito-Urinary Cancer Group. Seven year update of an EORTC phase III trial of high-dose intensity M-VAC chemotherapy and G-CSF versus classic M-VAC in advanced urothelial tract tumours. Eur J Cancer 2006; 42 (01) 50-54
- 14 Sonpavde G, Sternberg CN, Rosenberg JE, Hahn NM, Galsky MD, Vogelzang NJ. Second-line systemic therapy and emerging drugs for metastatic transitional-cell carcinoma of the urothelium. Lancet Oncol 2010; 11 (09) 861-870
- 15 Necchi A, Giannatempo P, Lo Vullo S. et al. Postchemotherapy lymphadenectomy in patients with metastatic urothelial carcinoma: long-term efficacy and implications for trial design. Clin Genitourin Cancer 2015; 13 (01) 80-86.e1
- 16 Abufaraj M, Dalbagni G, Daneshmand S. et al. The role of surgery in metastatic bladder cancer: a systematic review. Eur Urol 2018; 73 (04) 543-557
- 17 Patel V, Collazo Lorduy A, Stern A. et al. Survival after metastasectomy for metastatic urothelial carcinoma: a systematic review and meta-analysis. Bladder Cancer 2017; 3 (02) 121-132
- 18 Luzzi L, Marulli G, Solli P. et al. Long-term results and prognostic factors of pulmonary metastasectomy in patients with metastatic transitional cell carcinoma. Thorac Cardiovasc Surg 2017; 65 (07) 567-571
- 19 Muilwijk T, Akand M, Van der Aa F. et al. Metastasectomy of oligometastatic urothelial cancer: a single-center experience. Transl Androl Urol 2020; 9 (03) 1296-1305
- 20 Siefker-Radtke AO, Walsh GL, Pisters LL. et al. Is there a role for surgery in the management of metastatic urothelial cancer? The M. D. Anderson experience. J Urol 2004; 171 (01) 145-148
- 21 Matsuguma H, Yoshino I, Ito H. et al; Metastatic Lung Tumor Study Group of Japan. Is there a role for pulmonary metastasectomy with a curative intent in patients with metastatic urinary transitional cell carcinoma?. Ann Thorac Surg 2011; 92 (02) 449-453
- 22 Lehmann J, Suttmann H, Albers P. et al. Surgery for metastatic urothelial carcinoma with curative intent: the German experience (AUO AB 30/05). Eur Urol 2009; 55 (06) 1293-1299
- 23 Kim T, Ahn JH, You D. et al. Pulmonary metastasectomy could prolong overall survival in select cases of metastatic urinary tract cancer. Clin Genitourin Cancer 2015; 13 (04) e297-e304
- 24 Abe T, Kitamura H, Obara W. et al. Outcome of metastasectomy for urothelial carcinoma: a multi-institutional retrospective study in Japan. J Urol 2014; 191 (04) 932-936
- 25 Faltas BM, Gennarelli RL, Elkin E, Nguyen DP, Hu J, Tagawa ST. Metastasectomy in older adults with urothelial carcinoma: population-based analysis of use and outcomes. Urol Oncol 2018; 36 (01) 9.e11-9.e17
- 26 Sponholz S, Bölükbas S, Schirren M, Oguzhan S, Kudelin N, Schirren J. [Liver and lung metastases of colorectal cancer. Long-term survival and prognostic factors]. Chirurg 2016; 87 (02) 151-156
- 27 Pastorino U, Buyse M, Friedel G. et al; International Registry of Lung Metastases. Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 1997; 113 (01) 37-49