Metastasectomy in older adults with urothelial carcinoma: Population-based analysis of use and outcomes.
Urol Oncol
; 36(1): 9.e11-9.e17, 2018 01.
Article
en En
| MEDLINE
| ID: mdl-28988653
ABSTRACT
BACKGROUND:
Metastatic urothelial carcinoma of the bladder, ureter, or renal pelvis is a highly aggressive disease with poor outcomes. Even with platinum-based chemotherapy, the median overall survival is 15 months and the 5-year survival is only 15%. The role of metastasectomy in urothelial carcinoma is currently undefined.OBJECTIVE:
To examine the use and outcomes of metastasectomy in older patients with urothelial carcinoma in a large population-based dataset. DESIGN, SETTING, ANDPARTICIPANTS:
We conducted a SEER-Medicare study, and from 70,648 urothelial carcinoma patients who met inclusion criteria, we identified 497 patients who had at least 1 metastasectomy during a median follow-up of 40 months. OUTCOME MEASUREMENTS AND STATISTICALANALYSIS:
The primary study endpoints were metastasectomy use, the length of stay for metastasectomy, complications, and overall survival following metastasectomy. Secondary outcomes included 30-day mortality and readmission rate following metastasectomy. RESULTS ANDLIMITATIONS:
We identified 497 patients meeting inclusion criteria who had at least 1 metastasectomy during the study period including 24 patients who had more than 1 procedure resulting in a total of 523 metastasectomies. The median overall survival after the first metastasectomy was 19 months (95% CI 15-23; interquartile range 4-74). In this selected patient population, over a third of patients were alive at 3 years. In the 476 patients who had evaluable discharge dates, the median length of stay after metastasectomy was 7 days (IQR 4-12), and 10% of patients had at least 1 complication within 30 days of discharge. Thirty-day mortality after metastasectomy was 10% (n = 53/523) and was largely driven by the mortality associated with resections of urothelial cancer brain metastases.CONCLUSIONS:
In well-selected patients with urothelial carcinoma with a reasonable life expectancy, resection of metastatic lesions is safe and is associated with long-term survival and potential cures.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Neoplasias Urológicas
/
Metastasectomía
Tipo de estudio:
Prognostic_studies
Límite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
Urol Oncol
Asunto de la revista:
NEOPLASIAS
/
UROLOGIA
Año:
2018
Tipo del documento:
Article