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.

中文翻译：

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转移性尿路上皮癌患者转移瘤切除术的利用和结果：国家癌症数据库的分析

背景

寡转移性疾病的手术切除已被证明与其他恶性肿瘤的生存率提高有关，尽管其在转移性尿路上皮癌 (mUC) 中的作用尚未确定。我们试图使用 NCDB 数据库检查 mUC 中转移瘤切除术的使用趋势和相关结果。

方法

我们从 2004 年到 2016 年向 NCDB 查询了接受转移瘤切除术的转移性尿路上皮癌患者。通过线性回归评估转移瘤切除术的年利用率趋势。我们比较了倾向评分匹配的接受转移瘤切除术的患者与未使用双边对数秩和 Cox 回归模型的患者之间的总生存期 (OS)。我们还对 mUC 的亚组进行了敏感性分析。

结果

mUC 中转移瘤切除术的利用率为 7%，并且随着时间的推移没有显着变化。接受转移瘤切除术的患者平均年龄较小，患有>cT3疾病，对原发肿瘤进行了根治性手术，并接受了全身治疗。倾向评分匹配后，转移瘤切除术与 mUC 患者的 OS 获益无关（HR，0.94；95% CI，0.83 至 1.07；P = 0.38）。基于全身治疗、原发肿瘤根治性手术、临床 N 分期和疾病原发部位的分层亚组分析未显示转移灶切除术的 OS 益处。

结论

转移瘤切除术并不常见，尽管使用已持续了十多年。尽管选择偏倚和残余混杂有利于接受转移瘤切除术的患者，但我们发现这些个体和未接受转移瘤切除术的患者的 OS 相似。