Central Nervous System Metastasis in Patients With Urothelial Carcinoma: Institutional Experience and a Comprehensive Review of the Literature |
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| Affiliation: | 1. Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA;2. Division of Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA;3. Department of Urology, University of Washington, Seattle, WA;1. Department of Clinical & Experimental Medicine, Geriatrics Unit, University of Pisa, Italy;2. Department of Oncology, Unit of Oncology 1, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy;3. Bayer Healthcare Pharmaceuticals, Whippany, NJ, USA;4. Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy;5. Department of Medical Science and Public Health, Medical Oncology Unit, University of Cagliari, Cagliari, Italy;1. Department of Urology, University of Texas Health, San Antonio, TX;2. Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX;3. Urology and Nephrology Center, Mansoura University, Mansoura, Egypt;1. Department of Urology, Erasmus Medical Centre Rotterdam, The Netherlands;2. Department of Pathology, Erasmus Medical Centre Rotterdam, The Netherlands;1. Department of Radiology, Ufuk University School of Medicine, Ankara, Turkey;2. Department of Pathology, Ufuk University School of Medicine, Ankara, Turkey;3. Department of Thoracic Surgery, Ufuk University School of Medicine, Ankara, Turkey |
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| Abstract: | IntroductionCentral 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.Materials and MethodsWe 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.ResultsWe 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.ConclusionWe 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. |
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| Keywords: | Chemotherapy Cystectomy Secondary brain neoplasms Stereotactic radiation Transitional cell carcinoma |
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