Abstract
Background
The aim of the present study was to elucidate the details of bone metastasis (BM) and the resulting skeletal-related events (SREs), and survival and prognostic factors, in urothelial cancer (UC) patients with BM.
Methods
A total of 48 UC patients with BM who were treated at our institution between 1994 and 2013 were enrolled. Details of BM and SREs were investigated. The Kaplan–Meier method was used to estimate survival duration. Relationships between several clinical features and survival were analyzed using the log-rank test and the Cox hazard model.
Results
Of the 48 patients, 39 (81.3%) were male, with a median age at diagnosis of BM of 68 years [interquartile range (IQR), 61–75 years]. Frequent metastatic sites included the pelvis (31 patients, 64.6%) and spine (28, 58.3%). SREs occurred in 31 patients (64.6%) at a median duration of 0.9 months (IQR, 0.3–5.4 months) after diagnosis of BM, including radiation therapy (n = 23; 74.2%), spinal cord compression (n = 4; 12.9%), pathological fracture (n = 3; 9.7%) and hypercalcemia (n = 1; 3.2%). Median overall survival periods after diagnosis of BM and SREs were 6.2 and 5.6 months, respectively. On multivariate analysis, factors significantly associated with survival after BM were performance status [hazard ratio (HR) for ≥2 vs. 0–1, 4.94; P = 0.0003], liver metastasis (HR, 4.08; P = 0.0018), chemotherapy after BM (HR, 0.31; P = 0.0018), and use of bone-modifying agents (HR, 0.36; P = 0.0147).
Conclusions
We revealed clinicopathological factors that are predictive of prognosis of UC patients with BM. Although the prognosis is poor, chemotherapy and bone-modifying agents may confer survival benefits.
Similar content being viewed by others
References
Ferlay J, Soerjomataram I, Ervik M et al (2013) GLOBOCAN 2012 v1.0. Cancer incidence and mortality worldwide. IARC CancerBase No. 11. http://globocan.iarc.fr. Accessed April 2016
von der Maase H, Hansen SW, Roberts JT et al (2000) Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 18:3068–3077
Nakagawa T, Hara T, Kawahara T et al (2013) Prognostic risk stratification of patients with urothelial carcinoma of the bladder with recurrence after radical cystectomy. J Urol 189:1275–1281
Sengeløv L, Kamby C, von der Maase H (1996) Pattern of metastases in relation to characteristics of primary tumor and treatment in patients with disseminated urothelial carcinoma. J Urol 155:111–114
Bianchi M, Roghmann F, Becker A et al (2014) Age-stratified distribution of metastatic sites in bladder cancer: a population-based analysis. Can Urol Assoc J 8:E148–E158
Coleman RE (2006) Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res 12:6243–6249
Shinagare AB, Ramaiya NH, Jagannathan JP et al (2011) Metastatic pattern of bladder cancer: correlation with the characteristics of the primary tumor. AJR Am J Roentgenol 196:117–122
Shinagare AB, Fennessy FM, Ramaiya NH et al (2011) Urothelial cancers of the upper urinary tract: metastatic pattern and its correlation with tumor histopathology and location. J Comput Assist Tomogr 35:217–222
David S, Grady M (1987) Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits. Clin Orthop Relat Res 218:201–206
Forbes GS, McLeod RA, Hattery RR (1977) Radiographic manifestations of bone metastases from renal carcinoma. AJR Am J Roentgenol 129:61–66
Sturge J, Caley MP, Waxman J (2011) Bone metastasis in prostate cancer: emerging therapeutic strategies. Nat Rev Clin Oncol 8:357–368
Yokomizo A, Koga H, Shinohara N et al (2010) Skeletal-related events in urological cancer patients with bone metastasis: a multicenter study in Japan. Int J Urol 17:332–336
Kume H, Kakutani S, Yamada Y et al (2011) Prognostic factors for renal cell carcinoma with bone metastasis: who are the long-term survivors? J Urol 185:1611–1614
Drzymalski DM, Oh WK, Werner L et al (2010) Predictors of survival in patients with prostate cancer and spinal metastasis. J Neurosurg Spine 13:789–794
Taguchi S, Nakagawa T, Hattori M et al (2013) Prognostic factors for metastatic urothelial carcinoma undergoing cisplatin-based salvage chemotherapy. Jpn J Clin Oncol 43:923–928
Zaghloul MS, Boutrus R, El-Hossieny H et al (2010) A prospective, randomized, placebo-controlled trial of zoledronic acid in bony metastatic bladder cancer. Int J Clin Oncol 15:382–389
Morgan GJ, Davies FE, Gregory WM et al (2010) First-line treatment with zoledronic acid as compared with clodronic acid in multiple myeloma (MRC Myeloma IX): a randomised controlled trial. Lancet 376:1989–1999
Scagliotti GV, Hirsh V, Siena S et al (2012) Overall survival improvement in patients with lung cancer and bone metastases treated with denosumab versus zoledronic acid: subgroup analysis from a randomized phase 3 study. J Thorac Oncol 7:1823–1829
Ullen A, Schwarz S, Lennartsson L et al (2009) Zoledronic acid induces caspase-dependent apoptosis in renal cancer cell lines. Scand J Urol Nephrol 43:98–103
Yuasa T, Sato K, Ashihara E et al (2009) Intravesical administration of gamma-delta T cells successfully prevents the growth of bladder cancer in the murine model. Cancer Immunol Immunother 58:493–502
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest.
Funding
There was no funding for this study.
About this article
Cite this article
Tsuda, Y., Nakagawa, T., Shinoda, Y. et al. Skeletal-related events and prognosis in urothelial cancer patients with bone metastasis. Int J Clin Oncol 22, 548–553 (2017). https://doi.org/10.1007/s10147-016-1075-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10147-016-1075-9