Specifically, an oligometastatic disease has been defined as a number of metastases equal to or below three, amenable to treatment (from stereotactic to surgery alternatives).1 However, no previous studies addressed the survival according to the number and the location of metastatic sites. A novel population-based study, relying on Surveillance, epidemiology, and end results (SEER) database (2010-2020), represents one of the most contemporary hypotheses generating report on this unmet need.2 Specifically, it may help oncologists and urologists to acknowledge better the biological behavior of metastatic sites and their related survival in mUCUB.
The study included 1,310 metastatic BCA patients. All the mUCUB patients were exposed to systemic therapy and had a survival longer than at least 3 months, reducing the confounding effect of poor responders to systemic therapy.
Despite the SEER databases do not allow the identification the oligometastatic disease properly, the survival behavior related to the number of organ site metastases and their specific organ location may be helpful in understanding the natural history of such an aggressive disease.
Key Findings
- Higher is the number of metastatic sites, worse is the overall survival (OS). Interestingly, the OS detriments were very similar among BCA patients who harbored two and three sites of metastasis sites (median OS: 6 months).
- Among solitary metastatic sites mBCA patients, brain metastasis was associated with the worst survival (median OS: 6 months), while better survival was observed for lung metastasis (median OS: 11 months).
- Among two or more metastatic sites, there were recorded no differences considering every combination of the primary metastatic site (median OS ranged from 5 to 8 months).
Metastatic UCUB exhibited a peculiar organotropism. The most represented organ-site metastases were at bone, followed by lung, liver, and brain. The latter, despite its rarity (2%) may affect significantly and negatively the OS. In order to select mUCUB patients who may take advantage of further therapies, the current report should be used as a warning both for oncologists and urologists regarding the aggressiveness of mUCUB.
Written by: Francesco Di Bello, MD, Resident in Urology, University of Naples Federico II, Naples, Italy; Research fellow, University of Montréal Hospital Center (CHUM), Montréal, Canada
References:
- Bamias A, Stenzl A, Brown SL, Albiges L, Babjuk M, Birtle A, et al. Definition and Diagnosis of Oligometastatic Bladder Cancer: A Delphi Consensus Study Endorsed by the European Association of Urology, European Society for Radiotherapy and Oncology, and European Society of Medical Oncology Genitourinary Faculty. Eur Urol. ottobre 2023;84(4):381–9.
- Di Bello F, de Angelis M, Siech C, Jannello LMI, Peñaranda NR, Tian Z, et al. Survival of Metastatic Urothelial Carcinoma of Urinary Bladder According to Number and Location of Visceral Metastases. Clin Genitourin Cancer. 13 giugno 2024;22(5):102139.