EAU 2017: Can radical cystectomy be performed safely in the metastatic setting? Location of metastatic bladder cancer as a determinant of in-hospital mortality

London, England (UroToday.com) En lieu of recent commentary suggesting a possible role for radical cystectomy in the setting of metastatic urothelial carcinoma, Dr. Zaffuto and colleagues presented their population-based cohort study of perioperative outcomes among patients fitting these inclusion criteria at this afternoon’s EAU 2017 “Best Perioperative Outcomes from Cystectomy” poster session. Although cytoreductive nephrectomy has essentially become standard of care in surgically appropriate renal cell carcinoma patients, and other disease sites have anecdotally reported improved outcomes for patients undergoing cytoreductive procedures (prostate cancer), outcomes of surgical extirpation of the primary tumor has not been extensively evaluated among bladder cancer patients.

The primary objective of this study was to assess in-hospital mortality (IHM) rates among patients undergoing radical cystectomy, according to presence, absence and location of metastatic disease. The authors used the US National Inpatient Sample (NIS) database to identify 25,004 bladder cancer patients treated with radical cystectomy between 2004-2013 (n=19,965, 79.8% non-metastatic). Among the overall cohort, 5,049 had metastatic disease at the time of cystectomy. Patients were then stratified according to presence of non-regional lymph metastases (NRNM) without distant organ disease (n=3,323, 13.3%) vs distant organ metastases (DM) (n=1,726, 6.9%). IHM rates were 1.5%, 3.5% and 2.0% for NRNM, DM and non-metastatic patients, respectively. Using multivariable logistic regression analysis to assess IHM, DM patients were significantly associated with IHM (OR 1.68; 95%CI 1.26-2.20), whereas patients with NRNM (OR 0.84, 95%CI 0.62-1.11) had no association with IHM. Limitations of this study include the cross sectional nature of the NIS database, precluding assessment of comorbid conditions and perioperative outcomes once discharged from the hospital.

In summary, the authors suggest that radical cystectomy for highly select patients may be safe compared to patients without metastatic disease, however more robust studies taking into account the aforementioned limitations are necessary before widespread adoption of cystectomy in this setting is legitimized.

Presented by: Emanuele Zaffuto, Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy

Co-Authors: M. Moschini, S-R. Leyh-Bannurah, S. Gazdovich, P. Dell-Oglio, R. Pompe, S. Shariat, F. Montorsi, A. Briganti, F. Saad, P. Karakiewicz

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto
Twitter: @zklaassen_md

at the #EAU17 -March 24-28, 2017- London, England