Lehmann Jan, Suttmann Henrik, Albers Peter, Volkmer Björn, Gschwend Jürgen E, Fechner Guido, Spahn Martin, Heidenreich Axel, Odenthal Axel, Seif Christoph, Nürnberg Nils, Wülfing Christian, Greb Christoph, Kälble Tilmann, Grimm Marc-Oliver, Fieseler Claus Friedrich, Krege Susanne, Retz Margitta, Schulte-Baukloh Heiner, Gerber Martin, Hack Markus, Kamradt Jörn, Stöckle Michael
Department of Urology, Städtisches Krankenhaus Kiel, Kiel, Germany.
Eur Urol. 2009 Jun;55(6):1293-9. doi: 10.1016/j.eururo.2008.11.039. Epub 2008 Nov 29.
Recent publications suggest a benefit from surgical removal of urothelial carcinoma metastases (UCM) for a subgroup of patients.
We report the combined experience and outcome of patients undergoing resection of UCM gained at 15 uro-oncologic centers in Germany.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective survey of 44 patients with distant UCM of the bladder or upper urinary tract who underwent complete resection of all detectable metastases in 15 different German uro-oncological centers between 1991 and 2008.
Resected metastatic sites were the following: retroperitoneal lymph nodes (56.8%), distant lymph nodes (11.3%), lung (18.2%), bone (4.5%), adrenal gland (2.3%), brain (2.3%), small intestine (2.3%), and skin (2.3%). Systemic chemotherapy was administered in 35 of 44 patients (79.5%) before and/or after UCM surgery.
Overall, cancer-specific and progression-free survival from time of diagnosis and metastasectomy of UCM.
Median survival from initial diagnosis of UCM and subsequent resection was as follows: overall survival, 35 mo and 27 mo; cancer-specific survival, 38 mo and 34 mo; and progression-free survival, 19 mo and 15 mo. Overall 5-yr survival from metastasectomy for the entire cohort was 28%. Seventeen patients were still alive without progression at a median follow-up of 8 mo. Seven patients without disease progression survived for >2 yr and remained free from tumor progression at a median follow-up of 63 mo. No significant prognostic factors could be determined due to the limited patient number.
Long-term cancer control and possible cure can be achieved in a subgroup of patients following surgical removal of UCM. Metastasectomy in patients with disseminated UCM remains investigational and should only be offered to those with limited disease as a combined-modality approach with systemic chemotherapy.
近期发表的文献表明，对于一部分患者，手术切除尿路上皮癌转移灶（UCM）具有益处。
我们报告了德国15个泌尿肿瘤中心接受UCM切除术患者的综合经验及结果。
设计、地点和参与者：对1991年至2008年间在德国15个不同泌尿肿瘤中心接受所有可检测到的转移灶完全切除的44例膀胱或上尿路远处UCM患者进行回顾性调查。
切除的转移部位如下：腹膜后淋巴结（56.8%）、远处淋巴结（11.3%）、肺（18.2%）、骨（4.5%）、肾上腺（2.3%）、脑（2.3%）、小肠（2.3%）和皮肤（2.3%）。44例患者中有35例（79.5%）在UCM手术前和/或后接受了全身化疗。
总体而言，从UCM诊断和转移灶切除时间起的癌症特异性生存率和无进展生存率。
从UCM初始诊断和随后切除起的中位生存期如下：总生存期分别为35个月和27个月；癌症特异性生存期分别为38个月和34个月；无进展生存期分别为19个月和15个月。整个队列从转移灶切除起的5年总生存率为28%。17例患者在中位随访8个月时仍存活且无疾病进展。7例无疾病进展的患者存活超过2年，在中位随访63个月时仍无肿瘤进展。由于患者数量有限，无法确定显著的预后因素。
手术切除UCM后，一部分患者可实现长期癌症控制并可能治愈。对于播散性UCM患者，转移灶切除术仍处于研究阶段，仅应作为与全身化疗联合的综合治疗方法提供给疾病局限的患者。
