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Is the extirpative surgery for primary tumor helpful for the patients with metastatic urothelial cancer at the time of diagnosis?

 Jongchan Kim  ;  Sung Yul Park  ;  Ahmed Elghiaty  ;  Won Sik Jang  ;  Ji Eun Heo  ;  Jee Soo Park  ;  Young Deuk Choi  ;  Won Sik Ham 
 MEDICINE, Vol.98(22) : e15930-15936, 2019 
Journal Title
Issue Date
Aged ; Feasibility Studies ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Metastasis/therapy ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate ; Time Factors ; Time-to-Treatment/statistics & numerical data* ; Treatment Outcome ; Urologic Neoplasms/mortality* ; Urologic Neoplasms/pathology ; Urologic Neoplasms/surgery* ; Urothelium/pathology ; Urothelium/surgery*
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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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Chan(김종찬) ORCID logo https://orcid.org/0000-0002-0022-6689
Park, Jee Soo(박지수) ORCID logo https://orcid.org/0000-0001-9976-6599
Jang, Won Sik(장원식) ORCID logo https://orcid.org/0000-0002-9082-0381
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
Heo, Ji Eun(허지은) ORCID logo https://orcid.org/0000-0002-4184-8468
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