The role of primary site surgery in metastatic upper urinary tract urothelial carcinoma and a nomogram for predicting survival in patients with metastatic upper urinary urothelial carcinoma

This article was originally published here

Cancer Med. October 14, 2021. doi: 10.1002 / cam4.4327. Online ahead of print.

ABSTRACT

Metastatic upper urinary tract urothelial carcinoma (mUTUC) is a relatively rare urothelial carcinoma, and little attention has been paid to it. Our study established a nomogram by analyzing prognostic factors of mUTUC to predict patient survival and revealed the role of surgery at the primary tumor site. We extracted our data (2010-2016) from the Surveillance, Epidemiology, and End Results (SEER) database, and 628 patients with distant metastases were identified. Propensity score matching (PSM) was used to balance the bias of clinical variables in a 1: 1 ratio. After PSM, we recruited 502 patients in our study cohort. Univariate and multivariate Cox regression analyzes and Kaplan-Meier curves showed that T stage, N stage, liver metastases, surgery, and chemotherapy were prognostic factors for mUTUC before and after PSM. Based on the results, a nomogram was constructed to predict the 12 month survival of patients with distant metastases. Analysis of the T-stage, N-stage subgroups and different metastatic sites demonstrated that the survival of patients with T1 / T2, N0 / N1 / N2 / N3, metastases including the liver and metastases including bone could be improved by a combination of surgery and chemotherapy, while for patients with T3 / T4 / TX, NX, metastases including lungs and metastases including distant lymph nodes, chemotherapy alone was a better choice to improve their overall survival. Radiation therapy has been shown to be helpful for patients at stage N1 / N2 / N3. We have provided more specific treatment strategies for stage IV patients. Our research fully affirms the role of primary site surgery in UTUC patients with distant metastases and the importance of classifying patients into subgroups by integrating variables including T stage, N stage and different metastatic sites to select the optimal treatment method.

PMID:34647688 | DO I:10.1002 / cam4.4327

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