Oncotarget

Research Papers:

Can urologists introduce the concept of “oligometastasis” for metastatic bladder cancer after total cystectomy?

Koichiro Ogihara, Eiji Kikuchi _, Keitaro Watanabe, Ryohei Kufukihara, Yoshinori Yanai, Kimiharu Takamatsu, Kazuhiro Matsumoto, Satoshi Hara, Masafumi Oyama, Tetsuo Monma, Takeshi Masuda, Shintaro Hasegawa and Mototsugu Oya

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Oncotarget. 2017; 8:111819-111835. https://doi.org/10.18632/oncotarget.22911

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Abstract

Koichiro Ogihara1, Eiji Kikuchi1, Keitaro Watanabe2, Ryohei Kufukihara3, Yoshinori Yanai4, Kimiharu Takamatsu5, Kazuhiro Matsumoto1, Satoshi Hara6, Masafumi Oyama5, Tetsuo Monma3, Takeshi Masuda4, Shintaro Hasegawa2 and Mototsugu Oya1

1Department of Urology, Keio University School of Medicine, Tokyo, Japan

2Department of Urology, National Hospital Organization Tochigi Medical Center, Tochigi, Japan

3Department of Urology, National Hospital Organization Saitama Hospital, Saitama, Japan

4Department of Urology, Saitama City Hospital, Saitama, Japan

5Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan

6Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan

Correspondence to:

Eiji Kikuchi, email: eiji-k@kb3.so-net.ne.jp

Keywords: metastatic bladder cancer; total cystectomy; oligometastasis; prognosis; chemotherapy

Received: August 23, 2017    Accepted: November 16, 2017    Published: December 04, 2017

ABSTRACT

We investigated whether the concept of oligometastasis may be introduced to the clinical management of metastatic bladder cancer patients. Our study population comprised 128 patients diagnosed with metastatic bladder cancer after total cystectomy at our 6 institutions between 2004 and 2014. We extracted independent predictors for identifying a favorable. Occurrence that fulfilled all 4 criteria which were independently associated with cancer-specific death was defined as oligometastasis: a solitary metastatic organ; number of metastatic lesions of 3 or less; the largest diameter of metastatic foci of 5cm or less; and no liver metastasis. We evaluated differences in clinical outcomes between patients with oligometastasis (oligometastasis group) and those without oligometastasis (non-oligometastasis group). Overall, there were 43 patients in the oligometastasis group. The 2-year cancer-specific survival rate in the oligometastasis group was 53.3%, which was significantly higher than that in the non-oligometastasis group (16.1%, p<0.001). A multivariate analysis revealed that non-oligometastasis (p<0.001), not performing salvage chemotherapy (p<0.001), and not performing metastatectomy (p=0.028) were independent risk factors for cancer-specific death. In the subgroup of 83 patients who received salvage chemotherapy, 30 were in the oligometastasis group. The 2-year cancer-specific survival rate in the oligometastasis group was 55.0%, which was significantly higher than that in the non-oligometastasis group (22.0%, p=0.005). Non-oligometastasis (p=0.009) was the only independent risk factor for cancer-specific death. We presented that urothelial carcinoma with oligometastasis had a favorable prognosis and responded to systemic chemotherapy. Oligometastasis may be treated as a separate entity in the field of metastatic urothelial carcinoma.


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