Table 3 –
Studies reporting the outcomes of patients with metastatic bladder cancer who underwent pulmonary metastasectomy
| Reports | Patients (n) | Study population | Chemotherapy |
Surgery | Pathologic response rate | Survival |
||||
|---|---|---|---|---|---|---|---|---|---|---|
| Regimen (%) | Median no. of cycles | Median follow-up (mo) | Rate (%) | Median survival time (mo) | Other findings | |||||
| Otto et al. 2001 [34] | 70 | Metastatic BCa refractory to CHT | M-VAC | 3 | RC:100% Pulmonary resection: 30% Peritoneal deposit resection: 14% Liver resection: 11% |
0% | NR | 1-yr survival: 30% 2-yr survival: 19% |
7 | Symptomatic patients: 73% Asymptomatic patients: 27% No survival advantage for surgery Perioperative mortality: 4% |
| Bekku at al 2013 [23] | Original cohort: 47 Study population: 12 |
Patients with cPR to CHT who underwent surgery cM+ BCa (8) and UTUC (4) | GCP or MVAC 75% of patients received adjuvant CHT. | 3 | Primary surgery: 50% RPLND: 83% Pulmonary resection: 17%. |
pCR in pulmonary metastasis in one (50%) patient. pCR after RPLND in 8 (80%) patients |
33.6 | 3-yr PFS in patients with salvage surgery: 39.8% 3-yr PFS without salvage surgery was 0% 3-yr OS in surgery group: 71.6% 3-yr OS without surgery group: 12.1% |
Time to progression in patients undergoing salvage surgery 23 CSS in patients undergoing salvage surgery: 47.2 |
Resection of metastasis was significantly associated with CSS and time to progression |
| Matsuguma et al. 2011 [24] | 32 | UC with Pulmonary metastasis 81% had solitary metastasis | 50% patients received preoperative CHT | NR | Lobectomy: 47% wedge resection: 44% Segmentectomy: 9% |
NR | NR | 5-yr PFS: 26% 5-yr modified PFS: 40% 5-yr OS: 50% |
NR | 17 (53%) patients had recurrence after metastasectomy 9 (28%) patients survived without recurrence >5 yr |
| Han et al. 2002 [25] | 16 | UC with Pulmonary metastasis. | Adjuvant CHT GC | 3 | Wedge resection: 50% segmentectomy: 13% lobectomy: 37% |
NR | NR | 5-yr OS: 65.3% 5-yr DSS: 37.5% |
NR | 5 (31%) of patients with pulmonary recurrence underwent repeated metastasectomy and had a median survival of 31 mo No perioperative mortality |
| Siefker-Radtke et al. 2004 [26] | 31 | cM+ BCa (24) and UTUC (7) Lung metastasis: 77% Distant LNs: 13% Brain: 7% Subcutaneous tissue: 3% |
Preoperative CHT: 71% Adjuvant CHT: 13% Surgery alone: 29% |
NR | Primary surgery: 90% Complete pulmonary resection: 22/24 (90%). |
6.5% | 16 | 3-yr survival: 33% | OS from diagnosis: 31 OS from resection: 23 Time to recurrence: 7 |
No perioperative mortality |
| Abe et al. 2007 [27] | 48 | cM+ BCa (23), UTUC (16), synchronous BCa and UTUC (8), urethral carcinoma (1). | MVAC: 21% MEC: 63% |
4 | Resection of the primary site: 75% Metastasectomy: 21% (83% of them received preoperative CHT) |
Lung: 0% LN: 33% |
NR | NR | Whole cohort: 17 Patients who underwent metastasectomy: 42 Patients who did not undergo metastasectomy: 10 | Absence of liver, bone and local recurrence, >5 CHT cycles, and resection of metastasis were independent predictors of prolonged OS. |
| Lehmann et al. 2009 [28] | 44 patients | cM+ BCa (35) and UTUC (9) | Preoperative CHT: 50% Adjuvant CHT: 41% |
NR | Surgery alone: 20.5% Surgery+CHT: 29.5% CHT+surgery: 36.4% CHT+surgery+CHT: 13.6% |
After RPLND: 18% | 63 | 5-yr OS survival from diagnosis: 28% 5-yr OS survival from metastasis resection: 27.7% 5-yr PFS survival from diagnosis: 23.6% 5-yr PFS survival from metastasis resection: 24% |
OS from diagnosis, metastasis, and surgical resection: 34.7, 34.3 and 27.2 respectively | No perioperative death 7 patients survived >2 yr and remained free from tumor progression Metastasis site: RPLN (57%), distant LN (11%), lung (18%) and other (14%) |
| Kanzaki et al [29] 2010 | 18 | Pulmonary metastasis in patients with BCa (9), UTUC (6) and synchronous BCa and UTUC (3). | Perioperative platinum-based CHT 8 (44.4%) | NR | Sublobar resection: 77.8% Lobectomy: 22% Primary surgery TURB: 6% RC: 44% RNU:50% |
NR | 52 | 3-yr OS: 59.8% 5-yr OS: 46.5% 5-yr OS for solitary metastasis: 85.7% The 5-yr OS for multiple metastases: 20% |
NR | No perioperative mortality |
| Nakagawa et al [30] 2013 | 114 | Patients with local or distant recurrence after RC and PLND | Post recurrence platinum-based CHT: 53% | NR | Metastasectomy: 11.4% Lung: 7% LN: 3% Ileal conduit: 0.8% Brain: 0.8% |
NR | 11a | 1-yr OS: 48% 3-yr OS: 12% |
11 | Time to recurrence (≥1 yr, HR: 0.58), symptoms at recurrence (HR: 2.44), metastatic organs at recurrence (≥2, HR: 2.1), postrecurrence CHT (HR: 0.48) and metastasectomy (HR: 0.37) were independent predictors of postrecurrence OS |
| Abe et al. 2014 [31] | 42 | cM+ BCa (21), UTUC (18), synchronous BCa and UTUC (3) | Preoperative CHT: 81% | NR | RPLND: 36% Distant LN: 12% Pulmonary resection: 29% |
35.3% | 28 | 5-yr OS after metastasectomy: 31% | OS from metastasectomy: 26 | Patient who had metastasectomy in solitary LN or solitary lung lesion had significantly longer survival (81 versus 19) |
| Kim et al. 2015 [32] | 30 | cM+ BCa (14), UTUC (16) | Preoperative CHT: 6.7% Adjuvant CHT: 37% |
NR | Lung: 80% Liver: 7% Bone: 3% LN: 10% |
NR | 54 | 3-yr survival: 41%. | OS: 30 time to disease progression: 15.2 | Patients with nonpulmonary visceral metastases did not appear to benefit from surgery Initial stage IV disease (HR 4.28), pure urothelial pathology (HR 5.24), and nonpulmonary metastasectomy (HR 5.12) were independent predictors of time to disease progression |
| Luzzi et al. 2016 [33] | 69 | Pulmonary metastasis in BCa (55) and UTUC (14) | GC Carboplatin in case RNU | NR | Wedge or segmental resection: 64% Lobectomy: 36% |
NR | 50 | Overall 5-yr OS: 52% Overall 5-yr OS in BCa patients: 54% Overall 5-yr OS in UTUC pts: 48% |
OS: 62 disease-free interval: 37 |
No perioperative mortality Pulmonary metastasis <3 cm (HR 0.65) was independently associated with 5-yr OS Disease-free interval > 24 mo significantly related to a better 5-yr OS |
CHT = chemotherapy; CR = complete response; GC = gemcitabine and cisplatin; GCP = gemcitabine/cisplatin/paclitaxel-based; MVAC = methotrexate, vinblastine, doxorubicin, and cisplatin; MEC = mitoxantrone, etoposide, and intermediate-dose Ara-C; NR = not reported; OS = overall survival; PFS = progression-free survival; PLND = pelvic lymph node dissection; PR = partial response; RC = radical cystectomy; RNU = radical nephroureterectomy; RPLND = retroperitoneal lymph node dissection; TURB = transuretheral resection of the bladder; UC = urothelial carcinoma; UTUC = upper tract urothelial carcinoma.
a
Median follow-up (after recurrence) was 11 mo for all patients and 47 mo in 15 survivors at final follow-up.