Dong F, et al. - In patients with metastatic bladder cancer, researchers assessed the prognostic value of site-specific metastases and analyzed the roles that surgeries. As per current study, distant metastatic sites have differential impact on survival outcomes in these patients. For highly selected patients, surgeries, including radical cystectomy and metastasectomy, might still result in survival benefits.

Methods

• Researchers performed a population-based retrospective study using Surveillance, Epidemiology and End Results dataset and classified metastatic bladder cancer patients according to the sites of metastases (bone, brain, liver, lung and distant lymph nodes).
• They used Kaplan–Meier analysis with log-rank test for survival comparisons.
• To analyze the effect of distant metastatic sites on overall survival (OS) and cancer-specific survival (CSS), they used multivariate Cox regression model.

Results

• Researchers identified 1,862 patients with metastatic bladder cancer from 2010 to 2014.
• The most common metastatic sites were bone, lung and distant lymph nodes.
• Compared to patients without bone, brain, liver and lung involvement, patients with the corresponding sites of metastases had worse OS and CSS.
• In multivariate analysis, bone, brain, liver and lung metastases were independent prognostic factors for both OS and CSS, while distant node metastasis was not.
• Compared to patients with multisite metastases, patients with a single metastatic site also had more favorable OS (p < 0.001) and CSS (p < 0.001).
• Distant nodes and liver metastases represented the best and the worst prognosis among single-site metastatic patients.
• In addition, radical cystectomy independently predicted better OS and CSS, while in patients with liver metastasis and multiple metastatic sites, RC seemed not beneficial.
• Furthermore, metastasectomy seemed to be associated with favorable OS in patients with a single metastatic site (p=0.042), this was especially evident for patients with age <65 years (p=0.006) and for muscle-invasive bladder cancer patients (p=0.031).