Genitourinary Cancer

PV QA 1 - Poster Viewing Q&A 1

SU_27_2202 - Prognostic Significance of Sites of Metastatic Disease in Patients with Bladder Cancer

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Prognostic Significance of Sites of Metastatic Disease in Patients with Bladder Cancer
J. Budnik1, N. J. DeNunzio1, M. T. Milano2, and K. C. Bylund1; 1Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, 2University of Rochester Medical Center, Rochester, NY

Purpose/Objective(s): 5-year relative survival rates for bladder cancer have not increased significantly in the past 20 years per 2017 NCI figures. The prognosis for patients diagnosed with metastatic bladder cancer remains poor. In order to better understand prognostic factors in metastatic bladder cancer we investigated the significance of sites of metastatic disease using the Surveillance, Epidemiology, and End Results (SEER) database.

Materials/Methods: 3,105 patients from the SEER 18 registries diagnosed with metastatic bladder cancer from 2010-2014 were included in the analysis. Patients coded as having metastatic disease in bone, brain, liver, and lung were identified. Kaplan-Meier analyses, as well as univariate and multivariate Cox proportional hazards models were utilized to assess the impact of metastatic disease sites on overall survival (OS).

Results: Median age at diagnosis was 72 years. Median OS was 6 months. The majority of patients were white (n=2,617, 84.3%), male (n=2,213, 71.3%), and had urothelial carcinoma (n=2,315, 74.6%). 863 patients (27.8%) were coded as having no documented metastases in the bone, brain, liver, or lung (“M1NOS-group”), most likely reflecting distant lymph node metastases and/or extranodal intra-pelvic and/or intra-abdominal metastatic sites that are not specifically captured in the SEER registries. Those coded as having metastatic disease in the bone, without brain, liver, or lung metastases (“bone-group”, n=684, 22%); lung metastases, without bone, brain, or liver metastases (“lung-group”, n=562, 18.1%); and liver metastases, without bone, brain, or lung metastases (“liver-group”, n=324, 10.4%), were also common. With Cox regression accounting for age at diagnosis, race, sex, primary tumor site, histology, grade, T stage, and N stage, patients in the bone-group (HR=1.32, 95% CI 1.17-1.49, p<0.001), liver-group (HR=1.38, 95% CI 1.17-1.62, p<0.001), and lung-group (HR=1.14, 95% CI, 1.01-1.30, p<0.05), had poorer OS than those in the M1NOS-group. 646 patients (20.8%) were coded as harboring disease in multiple sites, and these patients also had poorer OS than those in the M1NOS-group (p<0.001). Female sex (HR=1.13, 95%CI 1.03-1.24, p<0.001) and squamous cell carcinoma histology (HR=1.86, 95% CI 1.49-2.33, p<0.001) were also associated with poorer OS than male sex, and patients with urothelial carcinoma, on multivariate analysis, respectively.

Conclusion: This hypothesis-generating analysis suggests that the prognosis of patients with metastatic bladder cancer not located in bone, brain, liver, or lung is improved relative to those harboring disease in any one, or a combination of these sites. This can inform future studies which seek to better understand or improve the prognosis of patients with metastatic bladder cancer.

Author Disclosure: J. Budnik: Resident physician; University of Rochester. N.J. DeNunzio: Employee; University of Rochester Medical Center. Honoraria; University of Rochester Department of Medicine, Boston University School of Medicine. Chief Resident/Instructor of Medicine; University of Rochester Medical Center. M.T. Milano: Honoraria; UpToDate. K.C. Bylund: None.

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