Background/objectives: The efficacy of lung metastasectomy in patients with urothelial carcinoma remains inconclusive, as there is only limited evidence from small studies. In this study, we aimed to assess the prognostic outcomes of excising pulmonary metastases from urothelial carcinoma. Methods: In this study, we utilized data from the Metastatic Lung Tumor Study Group of Japan database, a multi-institutional prospective database of pulmonary metastasectomies. We examined the data of patients who had undergone pulmonary metastasectomy for urothelial carcinoma between 1985 and 2021. Exclusion criteria included insufficient clinical information and follow-up of <3 months. Results: The study cohort comprised 100 patients (63 bladder cancer, 37 renal pelvic and ureteral cancer), with a median follow-up of 34 months. There were 70 male and 30 female patients of average age 66.5 ± 10.4 years at lung metastasectomy. The median interval from treatment of the primary lesion to metastasectomy was 19 months and the maximum tumor diameter was 21 ± 15 mm. Three- and five-year overall survival rates were 69% and 59%, respectively. Three- and five-year disease-free survival rates were 56% and 46%, respectively. Multivariate analysis identified larger tumor diameter (hazard ratio: 1.62, 95% confidence interval: 1.21–2.17) and distant metastases at the time of treatment of the primary cancer (hazard ratio: 4.23; 95% confidence interval: 1.54–11.6) as significant adverse prognostic factors for overall survival. Conclusions: To our knowledge, this is the largest published case series of pulmonary resection for metastatic urothelial carcinoma, providing benchmark data for the assessment of long-term outcomes of this rare entity.
背景/目的：尿路上皮癌患者肺转移瘤切除术的疗效尚无定论，目前仅有少量小型研究提供有限证据。本研究旨在评估尿路上皮癌肺转移灶切除的预后结局。方法：本研究利用日本转移性肺肿瘤研究组数据库（一项多机构前瞻性肺转移瘤切除术数据库）的数据，分析了1985年至2021年间因尿路上皮癌接受肺转移瘤切除术的患者资料。排除标准包括临床信息不足及随访时间少于3个月。结果：研究队列共纳入100例患者（63例膀胱癌，37例肾盂输尿管癌），中位随访时间为34个月。其中男性70例，女性30例，肺转移瘤切除术时平均年龄为66.5±10.4岁。从原发灶治疗到转移瘤切除术的中位间隔时间为19个月，最大肿瘤直径为21±15毫米。三年和五年总生存率分别为69%和59%，三年和五年无病生存率分别为56%和46%。多变量分析显示，较大肿瘤直径（风险比：1.62，95%置信区间：1.21-2.17）以及原发癌治疗时已存在远处转移（风险比：4.23；95%置信区间：1.54-11.6）是影响总生存率的显著不良预后因素。结论：据我们所知，这是目前已发表的最大规模转移性尿路上皮癌肺切除术病例系列研究，为评估这一罕见疾病的长期结局提供了基准数据。
Survival after Lung Metastasectomy from Urothelial Carcinoma: A Multi-Institutional Database Study
肿瘤(癌症)患者之家