ASCO GU 2018: The Role of Metastatic Burden in Cytoreductive/Consolidative Radical Cystectomy

San Francisco, CA (UroToday.com) At this afternoon’s poster session at GU ASCO, Dr. Roger Li presented on the role of metastatic burden with regard to the role of cytoreductive/consolidative radical cystectomy. The strategy of surgical extirpation of the primary tumor in the setting of metastatic disease has gained acceptance for a variety of solid tumors. However, the role of cytoreductive/consolidative radical cystectomy for metastatic urothelial cancer is largely unknown. The objective was to describe MD Anderson Cancer Center experience with cytoreductive/consolidative radical cystectomy for metastatic urothelial carcinoma and to investigate clinicopathologic features predicting prolonged cancer specific survival (CSS) following surgery.

The authors identified 43 patients undergoing cytoreductive/consolidative radical cystectomy with metastatic urothelial carcinoma originating from the lower urinary tract (1997-2011). Baseline demographics, regimen of chemotherapy, clinicopathologic features, and perioperative complications were collected. Progression free survival (PFS) and cancer specific survival (CSS) were estimated from the time of cytoreductive/consolidative radical cystectomy. Univariable and multivariable Cox regression models were used to identify predictors of improved CSS after cytoreductive/consolidative radical cystectomy.

Forty-one (95%) patients received chemotherapy prior to cytoreductive/consolidative radical cystectomy. There were 32 (74%) patients that had clinical evidence of distant metastases, while 11 were found to harbor occult metastases on the surgical specimen. The most common site of metastasis was the retroperitoneal lymph nodes, found in 30 patients. Additionally, solitary metastases were found in 22 patients (51%). The median PFS for patients with a single metastasis was 10.4 months (95%CI 4.1-NR) vs 3.5 months (95%CI 2.0-6.2) for multiple metastasis. The median CSS for patients with single metastasis was 26.0 months (95%CI 12.7-NR) compared to 7.9 months with multiple metastasis (7.9 months, 95%CI 3.8-11.4). On multivariable analysis, patients with multiple metastases were found to have worse CSS compared to those with solitary metastases (HR 2.62, 95%CI 1.16−5.90). Overall, 56% suffered postoperative complications, including a 2.3% perioperative mortality rate.

The authors concluded that cytoreductive/consolidative radical cystectomy is feasible in the setting of metastatic urothelial carcinoma, with comparable perioperative morbidity and mortality to radical cystectomy with curative intent. Patients with solitary metastasis demonstrated longer CSS than those with multiple metastases, and should be considered candidates for future trials evaluating the role of cytoreductive/consolidative radical cystectomy for metastatic urothelial carcinoma.

Speaker: Roger Li, MD Anderson Cancer Center, Houston, TX

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md, at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA