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Wang T, Gao X, Zhang K, Yang J, Wu Z, Liu T, Jia Q, Xiao J. Role of Multimodal Treatment in Urothelial Carcinoma Spinal Metastasis: 15 Patients' Experiences in a Single Center. Cancer Manag Res 2020; 12:9003-9012. [PMID: 33061595 PMCID: PMC7522434 DOI: 10.2147/cmar.s258429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/21/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose Spinal metastasis from urothelial carcinoma (UC) is relatively uncommon. The aim of the present study is to explore the clinicopathological features, surgical treatments and outcomes of this rare disease. Patients and Methods Fifteen patients with UC spinal metastasis who received surgery in our center between 2009 and 2018 were retrospectively investigated. Clinical data, treatment options, and outcomes were analyzed. Results For the 15 patients (9 men and 6 women), the primary tumors were located in the upper urothelial tract in ten and lower urothelial tract in five. UC mainly metastasized to the lumbar spine in seven cases, followed by the thoracic spine in five. Pathologic fracture and soft tissue mass with dura mater compression were observed in 66.7% and 93.3% cases, respectively. Palliative resection was performed in nine cases and excisional resection in six. Eleven patients received postoperative chemotherapy, including three with a preoperative ECOG score >2. Bisphosphonates were administered in all patients. Pain was relieved remarkably in all patients, and both the neurological function and general status were improved significantly after surgery. The median overall survival was 14 months. Log rank test showed that patients receiving postoperative chemotherapy survived longer than those without chemotherapy (p=0.037). WHO grade 3 was also correlated with poorer prognosis (p=0.012). Conclusion Pathological fracture and soft tissue mass with dura mater compression is frequently observed on radiological images in patients with UC spinal metastasis. Surgery is useful to prevent deterioration of performance status and improve quality of life, which provide an opportunity for further systematic therapy. Multimodal treatments, including surgery, postoperative chemotherapy and bisphosphonates are recommended. WHO grade 2 and receiving postoperative chemotherapy were favorable prognostic factors for the overall survival of patients with UC spinal metastasis.
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Affiliation(s)
- Tao Wang
- Department of Orthopaedic Oncology, Spinal Tumor Center, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
| | - Xin Gao
- Department of Orthopaedic Oncology, Spinal Tumor Center, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
| | - Kun Zhang
- Department of Orthopaedic Oncology, Spinal Tumor Center, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
| | - Jian Yang
- Department of Orthopaedic Oncology, Spinal Tumor Center, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
| | - Zheyu Wu
- Department of Orthopaedic Oncology, Spinal Tumor Center, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China.,Department of Orthopaedics, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, People's Republic of China
| | - Tielong Liu
- Department of Orthopaedic Oncology, Spinal Tumor Center, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
| | - Qi Jia
- Department of Orthopaedic Oncology, Spinal Tumor Center, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
| | - Jianru Xiao
- Department of Orthopaedic Oncology, Spinal Tumor Center, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
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Ishikawa Y, Tabei I, Fushimi A, Fuke A, Sekine C, Okamoto T, Takeyama H. Male breast metastasis of ureteral cancer: a case report. Surg Case Rep 2020; 6:58. [PMID: 32232598 PMCID: PMC7105547 DOI: 10.1186/s40792-020-00804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/12/2020] [Indexed: 12/09/2022] Open
Abstract
Background Breast metastasis from extra-mammary primary tumors is extremely rare. We recently experienced a rare case of a male breast metastasis of ureteral cancer and will provide a case report. Case presentation A 74-year-old man developed a ureteral cancer and underwent left nephroureterectomy with lymph node dissection. Although enlarged abdominal lymph nodes did not disappear completely after chemoradiotherapy, further extensive therapy was not performed. A mass just below the nipple of his right breast was acknowledged and he visited our department. Histological diagnosis was invasive carcinoma. It was initially diagnosed as a primary breast cancer, and he underwent a mastectomy and a sentinel lymph node biopsy. There was no intraductal lesion and the border of the tumor was clear. It was very similar to that of the previous ureteral cancer. The final diagnosis was breast metastasis of ureteral cancer rather than primary breast cancer. The postoperative course was good, but multiple lung metastases appeared 2 months after surgery. He eventually died of cancerous lymphangiopathy. Conclusion It is important to accurately diagnose primary breast cancer or breast metastasis so as not to cause extra-invasion, but it was considered difficult to make a complete preoperative diagnosis.
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Affiliation(s)
- Yoshitaka Ishikawa
- Moriya Keiyu Hospital Department of Surgery, 980-1 Tatsuzawa, Moriya-shi, Ibaraki, 302-0118, Japan
| | - Isao Tabei
- The Jikei University School of Medicine Daisan Hospital Department of Surgery, 4-11-1 Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan.
| | - Atsushi Fushimi
- The Jikei University School of Medicine Hospital Division of Breast Thyroid & Endocrine Surgery, 3-19-18 Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Azusa Fuke
- The Jikei University School of Medicine Daisan Hospital Department of Surgery, 4-11-1 Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Chikako Sekine
- The Jikei University School of Medicine Hospital Division of Breast Thyroid & Endocrine Surgery, 3-19-18 Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Tomoyoshi Okamoto
- The Jikei University School of Medicine Daisan Hospital Department of Surgery, 4-11-1 Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Hiroshi Takeyama
- The Jikei University School of Medicine Hospital Division of Breast Thyroid & Endocrine Surgery, 3-19-18 Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
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Kim J, Park SY, Elghiaty A, Jang WS, Heo JE, Park JS, Choi YD, Ham WS. Is the extirpative surgery for primary tumor helpful for the patients with metastatic urothelial cancer at the time of diagnosis? Medicine (Baltimore) 2019; 98:e15930. [PMID: 31145361 PMCID: PMC6708713 DOI: 10.1097/md.0000000000015930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The stagnant mortality rates for metastatic urothelial cancer (UC) have provoked efforts to find novel treatments. To test the utility of the extirpative surgery for primary tumor as an option for these patients, we investigated the perioperative and oncologic outcomes of surgery for primary tumors in metastatic UC patients.We reviewed the medical records of 130 metastatic UC patients (bladder: 88, upper tract UC: 42) at diagnosis from November 2005 to November 2016. A total of 56 patients (surgery group) underwent chemotherapy with extirpative surgery for the primary tumor, and 74 patients (non-surgery group) received chemotherapy. We evaluated perioperative outcomes, cancer-specific survival (CSS), and overall survival (OS) using Kaplan-Meier methods and factors related to OS and CSS using Cox regression models.Surgery group showed similar perioperative outcome and postoperative complications to those previously reported in UC patients without metastasis, and fewer urinary complications than non-surgery group. Surgery group showed better oncological outcomes than non-surgery group for median CSS (16.0 vs 10.0 months, P = 0.014) and median OS (14.0 vs 9.0 months, P = 0.043). Multivariate analysis showed Eastern Cooperative Oncology Group performance status and metastasis to liver as significant predictors of CSS and OS. Surgery was not related with OS, but a significant predictor of CSS.Extirpative surgery for primary tumor in metastatic UC can be feasible and it might have survival benefits, especially those patients with a tolerable general condition and no liver metastasis. In addition, LT reduces the possibility of a surgical procedure towing to urinary complications.
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Affiliation(s)
- Jongchan Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine
| | - Sung Yul Park
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Ahmed Elghiaty
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine
- Department of Urology, Tanta University Medical School, Egypt
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine
| | - Ji Eun Heo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine
| | - Jee Soo Park
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine
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Abufaraj M, Dalbagni G, Daneshmand S, Horenblas S, Kamat AM, Kanzaki R, Zlotta AR, Shariat SF. The Role of Surgery in Metastatic Bladder Cancer: A Systematic Review. Eur Urol 2017; 73:543-557. [PMID: 29122377 DOI: 10.1016/j.eururo.2017.09.030] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/28/2017] [Indexed: 12/27/2022]
Abstract
CONTEXT The role of surgery in metastatic bladder cancer (BCa) is unclear. OBJECTIVE In this collaborative review article, we reviewed the contemporary literature on the surgical management of metastatic BCa and factors associated with outcomes to support the development of clinical guidelines as well as informed clinical decision-making. EVIDENCE ACQUISITION A systematic search of English language literature using PubMed-Medline and Scopus from 1999 to 2016 was performed. EVIDENCE SYNTHESIS The beneficial role of consolidation surgery in metastatic BCa is still unproven. In patients with clinically evident lymph node metastasis, data suggest a survival advantage for patients undergoing postchemotherapy radical cystectomy with lymphadenectomy, especially in those with measurable response to chemotherapy (CHT). Intraoperatively identified enlarged pelvic lymph nodes should be removed. Anecdotal reports of resection of pulmonary metastasis as part of multimodal approach suggest possible improved survival in well-selected patients. Cytoreductive radical cystectomy as local treatment has also been explored in patients with metastatic disease, although its benefits remain to be assessed. CONCLUSIONS Consolidative extirpative surgery may be considered in patients with clinically evident pelvic or retroperitoneal lymph nodal metastases but only if they have had a response to CHT. Surgery for limited pulmonary metastases may also be considered in very selected cases. Best candidates are those with resectable disease who demonstrate measurable response to CHT with good performance status. In the absence of data from prospective randomized studies, each patient should be evaluated on an individual basis and decisions made together with the patient and multidisciplinary teams. PATIENT SUMMARY Surgical resection of metastases is technically feasible and can be safely performed. It may help improve cancer control and eventually survival in very selected patients with limited metastatic burden. In a patient who is motivated to receive chemotherapy and to undergo extirpative surgical intervention, surgery should be discussed with the patient among other consolidation therapies in the setting of multidisciplinary teams.
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Affiliation(s)
- Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Guido Dalbagni
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Siamak Daneshmand
- Institute of Urology, University of Southern California/ Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Simon Horenblas
- Department of Surgical Oncology, Division of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Alexandre R Zlotta
- Department of Surgery, Division of Urology, University of Toronto, Mount Sinai Hospital and University Health Network, Toronto, ON, Canada
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA.
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Inokuchi J, Kuroiwa K, Kakehi Y, Sugimoto M, Tanigawa T, Fujimoto H, Gotoh M, Masumori N, Ogawa O, Eto M, Ohyama C, Yamaguchi A, Matsuyama H, Ichikawa T, Asano T, Mizusawa J, Eba J, Naito S. Role of lymph node dissection during radical nephroureterectomy for upper urinary tract urothelial cancer: multi-institutional large retrospective study JCOG1110A. World J Urol 2017; 35:1737-1744. [DOI: 10.1007/s00345-017-2049-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/08/2017] [Indexed: 02/06/2023] Open
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Inokuchi J, Eto M, Hara T, Fujimoto H, Nishiyama H, Miyazaki J, Kikuchi E, Hinotsu S, Koie T, Ohyama C. Impact of lymph node dissection on clinical outcomes during nephroureterectomy in patients with clinically node-negative upper urinary tract urothelial cancer: subanalysis of a multi-institutional nationwide case series of the Japanese Urological Association. Jpn J Clin Oncol 2017; 47:652-659. [DOI: 10.1093/jjco/hyx051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/22/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Junichi Inokuchi
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Tomohiko Hara
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Urology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Fujimoto
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Urology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Nishiyama
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Jun Miyazaki
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Eiji Kikuchi
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Department of Urology, Keio University School of Medicine, Tokyo
| | - Shiro Hinotsu
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama
| | - Takuya Koie
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Working Group of the Renal Pelvic and Ureteral Cancer Registration Committee of the Japanese Urological Association
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Miyata Y, Sakai H. Editorial Comment from Dr Miyata and Dr Sakai to Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer: Subanalysis of the multi-institutional nationwide case series study of the Japanese Urological Association. Int J Urol 2016; 23:230-1. [PMID: 26840209 DOI: 10.1111/iju.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yasuyoshi Miyata
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Hideki Sakai
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Sakano S, Matsuyama H. Editorial Comment from Dr Sakano and Dr Matsuyama to Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer: Subanalysis of the multi-institutional nationwide case series study of the Japanese Urological Association. Int J Urol 2016; 23:231-2. [PMID: 26822627 DOI: 10.1111/iju.13057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shigeru Sakano
- Department of Urology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan. .,Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan.
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
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