Metastasectomy for patients with metastatic urothelial cancer (mUC) does not significantly improve overall survival (OS), according to a recent study.
Using the National Cancer Database, a team led by Raj Satkunasivam, MD, of Houston Methodist Hospital in Houston, Texas, identified 11,601 patients diagnosed with mUC from 2004 to 2016. Of these, 817 underwent metastastectomy and 10,784 who did not. The investigators matched 556 patients in each group by propensity score. In this matched group, the median OS was 9.1 months for those who underwent metastasectomy and 7.7 months for those who did not, Dr Satkunasivam and colleagues reported in Urologic Oncology. The 2-year OS survival rates were 16.7% and 14.4%, respectively. The 5-year rates were 6.2% and 4.9%, respectively. These between-group differences were not statistically significantly.
In subgroup analyses, metastasectomy had no survival benefit regardless of whether patients received systemic therapy or radical surgery to the primary tumor, clinical N stage, and primary location of the primary tumor (bladder vs upper tract), the investigators reported.
The study found that the overall utilization rate of metastasectomy in mUC was 7% and did not change significantly over time (5.38% in 2004 and 7.19% in 2016).
“Although our study did not show a benefit on OS for metastasectomy in mUC, smaller retrospective studies demonstrated a potential benefit in patients with a good response to systemic therapy and low volume disease,” the authors wrote. “Those with higher volume metastatic disease, visceral or bone metastasis, or poor response to systemic therapy are unlikely to benefit from metastasectomy in mUC with regards to OS.”
Dursun F, Mackay A, Guzman JCA, et al. Utilization and outcomes of metastasectomy for patients with metastatic urothelial cancer: An analysis of the national cancer database. Urol Oncol. Published online August 1, 2021. doi:10.1016/j.urolonc.2021.07.015