Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA.
Division of Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA.
Clin Genitourin Cancer. 2020 Jun;18(3):e266-e276. doi: 10.1016/j.clgc.2019.11.008. Epub 2019 Dec 5.
Central nervous system (CNS) metastasis in patients with urothelial carcinoma (UC) is uncommon and poorly understood. We aimed to explore the clinical behavior and outcomes of this unique patient population.
We performed a retrospective analysis of patients with UC and CNS metastasis, treated in our institution (2006-2018), along with an exploratory patient-point meta-analysis of a similar patient population derived from a comprehensive literature review. Data regarding diagnosis, management, and outcomes were extracted. Overall survival, time to CNS metastasis (TTCM), and residual survival (RS) from CNS involvement to death were calculated (Kaplan-Meier method). Cox regression was used for testing key clinicopathologic associations.
We identified 20 "institutional" and 154 "literature" patients with adequate data granularity for analysis. Median TTCM was 17.7 (institutional cohort) and 10 (literature cohort) months. Most patients who developed CNS metastases had previous non-CNS metastasis (15/20 [75%] and 103/154 [67%], respectively). CNS lesions without previous history of metastasis were identified in 5/20 (25%) and 33/154 (21%) cases and those patients had a shorter TTCM. CNS lesions in the absence of known UC history were also documented in 18/154 (12%) literature cases. Multifocal CNS disease was associated with shorter RS in both cohorts in univariate, but not multivariate, analysis.
We observed a variability in disease presentation and course, with a subset of patients showing an early predilection for CNS insult, potentially reflecting a diverse underlying biology. Genomic profiling studies, elucidating the molecular landscape, and driving future treatments should be considered in this setting.
尿路上皮癌（UC）患者的中枢神经系统（CNS）转移并不常见，也了解甚少。我们旨在探索这一独特患者群体的临床行为和结局。
我们对在我院（2006-2018 年）接受治疗的 UC 伴 CNS 转移患者进行了回顾性分析，并对综合文献复习中获得的类似患者群体进行了探索性患者点荟萃分析。提取了有关诊断、治疗和结局的数据。使用 Kaplan-Meier 法计算总生存期、CNS 转移时间（TTCM）和从 CNS 累及到死亡的残余生存期（RS）。Cox 回归用于检验关键的临床病理关联。
我们确定了 20 名“机构”和 154 名“文献”患者，他们的数据粒度足以进行分析。中位 TTCM 为 17.7（机构队列）和 10 个月（文献队列）。大多数发生 CNS 转移的患者之前有非 CNS 转移（分别为 15/20 [75%]和 103/154 [67%]）。在 5/20（25%）和 33/154（21%）病例中发现了没有先前转移史的 CNS 病变，这些患者的 TTCM 较短。在 18/154（12%）文献病例中也记录了无已知 UC 病史的 CNS 病变。在单变量分析中，两组均有多发 CNS 疾病与 RS 较短相关，但在多变量分析中则不然。
我们观察到疾病表现和病程存在差异，有一部分患者表现出早期 CNS 损伤的倾向，这可能反映了不同的潜在生物学机制。在这种情况下，应考虑进行基因组分析研究，以阐明分子图谱并推动未来的治疗。
