Utilization and outcomes of metastasectomy for patients with metastatic urothelial cancer: An analysis of the national cancer database Academic Article uri icon

abstract

  • Background

    Surgical resection of oligometastatic disease has been shown to be associated with an improved survival in other malignancies, though its role is not established in metastatic urothelial carcinoma (mUC). We sought to examine utilization trends of metastasectomy in mUC and associated outcomes using the NCDB database.

    Methods

    We queried the NCDB from 2004 to 2016 for patients with metastatic urothelial carcinoma who had undergone metastasectomy. The annual utilization trend of metastasectomy was evaluated by linear regression. We compared overall survival (OS) between propensity score matched patients who had undergone metastasectomy and those who had not using two-sided log-rank and Cox regression models. We also performed sensitivity analyses on subcohorts of mUC.

    Results

    The utilization rate of metastasectomy in mUC was 7% and did not change significantly over time. Patients who received metastasectomy on average were younger, had >cT3 disease, had radical surgery to the primary tumor, and received systemic therapy. After propensity score matching, metastasectomy was not associated with an OS benefit for mUC patients (HR, 0.94; 95% CI, 0.83 to 1.07; P=0.38). Stratified subgroup analysis based on systemic therapy, radical surgery to primary tumor, clinical N stage, and primary location of disease did not show an OS benefit of metastasectomy.

    Conclusion

    Metastasectomy is uncommonly used, though utilization has persisted over more than a decade. Despite selection biases and residual confounding favoring patients undergoing metastasectomy, we found similar OS among these individuals and those who did not undergo metastasectomy.

published proceedings

  • Urologic Oncology: Seminars and Original Investigations

altmetric score

  • 18.7

author list (cited authors)

  • Dursun, F., Mackay, A., Guzman, J., Wenker, E., Klaassen, Z., O'Malley, P., ... Satkunasivam, R.

citation count

  • 0

complete list of authors

  • Dursun, Furkan||Mackay, Alexander||Guzman, Jonathan CA||Wenker, Evan||Klaassen, Zachary||O'Malley, Padraic||Bhindi, Bimal||Perez, Cinthya Obando||Xu, Jiaqiong||Roh, Taehyun||Sonpavde, Guru||Wallis, Christopher JD||Satkunasivam, Raj

publication date

  • February 2022