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Thomas Flaig, MD


Upper Tract Urothelial Cancer: Prognostic Relevance of the Site of Metastases

By: Celeste L. Dixon
Posted: Thursday, October 13, 2022

The location of metastases in patients with metastatic upper tract urothelial carcinoma appears to have prognostic significance, according to research based on Surveillance, Epidemiology, and End Results (SEER) data published in the Journal of Clinical Medicine by Antonio Giordano, MD, PhD, of Temple University, Philadelphia, and colleagues. They found that a distant lymph node was the most common site of single-organ metastases in this patient population. In addition, those with liver metastases and multiple-organ metastases had the poorest survival outcomes.

Metastases to the liver or to more than one organ were predictors of poorer survival, both compared with metastases to single organs other than the liver. Specifically, in patients with a single metastatic organ site, overall survival was significantly worse for those with liver metastases versus metastases in a distant lymph node (P < .001), bone (P = .023), or lung (P = .026). Single-organ liver metastases were least common among the four sites, however; metastases to distant lymph nodes were most prevalent, accounting for 36%, followed by lung, bone, and liver metastases, at 26%, 22.8%, and 16.2%, respectively. In multivariate analyses, metastasis to the liver (P < .001 and P = .022) or to multiple organs (P < .001 and P = .002) were independent predictors of poorer overall survival and cancer-specific survival, respectively.

Of the 633 patients treated from 2004 to 2016 and followed for a median of 6 months, 584 (92.3%) died in the follow-up period. Still, the survival benefits of radical nephroureterectomy and chemotherapy were statistically significant, at P = .005 and P = .006 for overall and cancer-specific survival, respectively, with surgery and at P < .001 for both overall and cancer-specific survival with chemotherapy. These results “justify aggressive treatment in patients [with] oligometastatic [disease],” concluded Dr. Giordano and co-investigators.

Disclosure: The study authors reported no conflicts of interest.

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