Al-Nader Mulham, Krafft Ulrich, Darr Christopher, Heß Jochen, Kesch Claudia, Püllen Lukas, Tschirdewahn Stephan, Yesilyurt Umut-Ulas, Isgandarov Aykhan, Hadaschik Boris, Mahmoud Osama
Department of Urology, University Hospital Essen, Essen, Germany.
Department of Urology, University Hospital Essen, Essen, Germany,
Urol Int. 2025;109(4):337-345. doi: 10.1159/000542982. Epub 2024 Dec 16.
The impact of surgical therapy on selected patients with limited metastatic/recurrence burden has not yet been well studied. We investigated the outcome of surgical resection for patients with local recurrence only or oligometastatic urothelial carcinoma (UC) of the bladder.
We identified patients with oligometastatic UC or local recurrence only after radical cystectomy who underwent surgical resection with curative intent between 2003 and 2022 at our center. Oligometastatic UC was defined as three or fewer resectable lesions, regardless of the number of organs involved. We studied the surgical outcome, progression-free survival (PFS) and overall survival (OS) in this selected group of patients.
A total of 39 patients were selected, including 18 (46%) with local recurrence and 21 (54%) with oligometastatic UC. Nine patients (23%) experienced intraoperative complications, all of whom belonged to the local recurrence group, while 8 patients (20.5%) experienced major postoperative complications, including 6 patients from the local recurrence group and 2 patients with oligometastatic disease. The median PFS following surgery was 19 months (95% CI; 2.5-35.5) with 1- and 3-year progression rates of 47% and 29%, while the median OS was 24 months (95% CI; 8.6-39.3) with 1- and 3-year survival rates of 51% and 30%. A significantly better median PFS was observed in the metastatic versus local recurrence group (35 vs. 8 months, p = 0.01). Similarly, a median OS of 41 months was observed in the metastatic group compared to only 12 months for the local recurrence group (p = 0.12). Overall, a better survival time of 30 months was observed in the metachronous group compared to 6 months in the synchronous group (p = 0.046). In a further analysis of the metastatic group, metachronous oligometastasis was associated with a longer survival of 43 months compared to 9 months for synchronous metastasis (p = 0.18). Some differences were not significant, which may be due to sample size.
Our study shows reasonable surgical and survival outcomes of metastasectomy, especially in the metachronous subgroup, for UC without risk of higher perioperative morbidity. On the other hand, resection of local recurrence is associated with a higher risk of incomplete resection and higher intraoperative and postoperative morbidity without offering a survival benefit.
手术治疗对选定的转移/复发负担有限的患者的影响尚未得到充分研究。我们调查了仅局部复发或寡转移膀胱尿路上皮癌（UC）患者手术切除的结果。
我们确定了2003年至2022年期间在我们中心接受根治性膀胱切除术后仅发生寡转移UC或局部复发且接受了根治性手术切除的患者。寡转移UC定义为可切除病灶不超过三个，无论涉及的器官数量。我们研究了这组选定患者的手术结果、无进展生存期（PFS）和总生存期（OS）。
共入选39例患者，其中18例（46%）为局部复发，21例（54%）为寡转移UC。9例患者（23%）发生术中并发症，均属于局部复发组，而8例患者（20.5%）发生术后严重并发症，包括局部复发组6例和寡转移组2例。术后中位PFS为19个月（95%CI；2.5 - 35.5），1年和3年进展率分别为47%和29%，而中位OS为24个月（95%CI；8.6 - 39.3），1年和3年生存率分别为51%和30%。转移组的中位PFS明显优于局部复发组（35个月对8个月，p = 0.01）。同样，转移组的中位OS为41个月，而局部复发组仅为12个月（p = 0.12）。总体而言，异时性组的生存时间为30个月，优于同时性组的6个月（p = 0.046）。在对转移组的进一步分析中，异时性寡转移的生存期为43个月长于同时性转移的9个月（p = 0.18）。一些差异不显著，这可能是由于样本量的原因。
我们的研究表明，对于无高围手术期发病率风险的UC患者，尤其是在异时性子组中，转移灶切除术具有合理的手术和生存结果。另一方面，局部复发的切除与不完全切除的高风险以及更高的术中和术后发病率相关，且未带来生存益处。
