Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
McMaster University, Hamilton, Ontario, Canada.
Clin Genitourin Cancer. 2018 Apr;16(2):e483-e490. doi: 10.1016/j.clgc.2017.10.012. Epub 2017 Nov 1.
Patients with exclusive bone metastatic spread from urothelial carcinoma (UC) throughout their disease course represent a rare subgroup with unique clinical features. These patients deserved special consideration in a retrospective multicenter study.
Analyses were made from a pool of 1911 patients with a diagnosis of metastatic UC, from 23 centers. Baseline characteristics, access to treatment, and outcomes were analyzed according to metastatic spread. Univariable and multivariable Cox analyses were performed.
A total of 128 evaluable patients (6.7%), diagnosed between February 1997 and April 2013, were identified. Eastern Cooperative Oncology Group performance status (PS) was ≥ 2 in 33.3% versus 17.7% of the remaining patients. Seventy-three (57%) received first-line chemotherapy, that was platinum-based in 50 patients (69%). Twenty-eight (21.9%) received second-line chemotherapy (vs. 75.9% and 32.2%, respectively, of the remaining patients). In multivariable analyses, no clinical factor was significantly associated with overall survival (OS). Among platinum chemotherapy-treated patients (total evaluable n = 972), significantly different relapse-free survival (RFS) and OS were observed according to bone metastases status (no bone metastases vs. bone metastases only vs. bone and other sites, P < .001). In these groups, 2-year RFS was 37.4%, 28.8%, and 25.9%, respectively. Two-year OS was 35.5%, 15.8%, and 23%, respectively.
Patients with metastatic UC and bone-only metastases are less likely to receive systemic therapy than those with other metastases, likely because of their lower PS. The prognostic effect of having exclusive bone metastases or additional sites seems to be equally poor. These patients deserve new effective and tolerable agents, and improvements in the knowledge of their disease.
在整个疾病过程中仅发生骨转移的尿路上皮癌（UC）患者是一种罕见的亚组，具有独特的临床特征。这些患者在回顾性多中心研究中应得到特别关注。
对来自 23 个中心的 1911 例转移性 UC 患者的队列进行了分析。根据转移情况分析了基线特征、治疗途径和结局。进行了单变量和多变量 Cox 分析。
共鉴定出 128 例可评估患者（6.7%），他们于 1997 年 2 月至 2013 年 4 月之间被诊断。东部合作肿瘤组（ECOG）体能状态（PS）≥2 者占 33.3%，其余患者占 17.7%。73 例（57%）患者接受了一线化疗，其中 50 例（69%）接受了基于铂类的化疗。28 例（21.9%）患者接受二线化疗（而其余患者分别为 75.9%和 32.2%）。多变量分析中，没有临床因素与总生存（OS）显著相关。在接受铂类化疗的患者中（总可评估 n=972），根据骨转移状态观察到明显不同的无复发生存（RFS）和 OS（无骨转移与仅骨转移与骨和其他部位，P<0.001）。在这些组中，2 年 RFS 分别为 37.4%、28.8%和 25.9%，2 年 OS 分别为 35.5%、15.8%和 23%。
与其他转移部位相比，仅有骨转移的转移性 UC 患者更不可能接受全身性治疗，这可能是由于他们的 PS 较低。仅发生骨转移或发生其他部位转移的患者预后似乎同样较差。这些患者需要新的有效和可耐受的药物，并提高对其疾病的认识。
