Efficacy of Cytoreductive Surgery for Metastatic Upper Tract Urothelial Carcinoma: A Surveillance, Epidemiology and End Results (SEER) study of 508 patients

Abstract Objective To explore the role of cytoreductive surgery (CRS) in patients with metastatic upper tract urothelial carcinoma (mUTUC) receiving different types of adjuvant therapy. Material and Methods Data from 9,436 anonimized records was abstracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2008–2018. Of these, 508 individuals had received adjuvant therapy subsequent to being diagnosed with mUTUC. These patients had all been treated with adjuvant therapies such as chemotherapy and/or radiotherapy. Patients were stratified into either a non-surgical or surgical group based on CRS status before adjuvant therapeutics commenced. Kaplan-Meier curves were used to compare OS and CSS. Cox’s proportional hazard models were then used to analyze prognostic factors related to OS and CSS. Results Of the 508 cases, 36.8% (n = 187) had received CRS with adjuvant treatments. The remaining 63.2% (n = 321) received either chemotherapy and/or radiotherapy alone. Kaplan-Meier curves showed that 11.6% had 3-yr OS (95%CI 7.1–17.3) for CRS with adjuvant treatment and 4.9% (95%CI 2.7–8.0) for adjuvant treatment alone (p = 0.001). The 3-yr CSS was 14.9% for CRS plus adjuvant treatment (95%CI 9.4–21.7) and 6.0% (95%CI 3.4–9.8) for adjuvant treatments alone (p = 0.003). Under multivariate regression analysis, primary ureter site OS had a hazard ratio (HR) of 0.74 (95%CI 0.58–0.95, p = 0.019) and a CSS HR of 0.72 (95%CI 0.56–0.94, p = 0.014). The CRS OS HR was 0.79 (95%CI 0.65–0.95, p = 0.015) and the CSS HR was 0.75 (95%CI 0.61–0.92, p = 0.006). Additionally, chemotherapy had an OS HR of 0.46 (95%CI 0.33–0.0.65, p < 0.001) and a CSS HR of (0.44, 95%CI 0.31–0.63, p < 0.001). Bones and liver metastases were also indicative of poorer prognosis. Validation was conducted through subgroup analysis which suggested CRS was effective only for patients who received chemotherapy or combined chemo-radiotherapy but not for radiotherapy alone. Conclusions CRS provided significantly increased OS and CCS for mUTUC patients who received chemotherapy or combined chemo-radiotherapy in this study. In addition, the primary tumor and metastatic sites were related to improved patient survival although this was a small, relatively homogeneous sample therefore further research is required.