Search

Introduction and Aim of the Study: The impact of surgical therapy in selected patients with limited metastatic/recurrence burden have not yet been well studied. We investigated the outcome of surgical resection for patients with local recurrence only or oligometastatic UC of the bladder., Patients and Methods: We identified patients with oligometastatic UC or local recurrence only after radical cystectomy (RC) who underwent surgical resection with curative intent between 2003 and 2022 at our center. Oligometastatic UC was defined as three or fewer resectable lesions, regardless of the number of organs involved. We studied the surgical outcome, progression-free survival (PFS) and overall survival (OS) in this selected group of patients., Results: A total of 39 patients were selected, including 18 (46%) with local recurrence and 21 (54%) with oligometastatic UC. Nine patients (23%) experienced intraoperative complications, all of whom belonged to the local recurrence group, while eight patients (20.5%) experienced major postoperative complications, including six patients from the local recurrence group and two patients with oligometastatic disease. The median PFS following surgery was 19 months (95% CI; 2.5-35.5) with 1- and 3-year progression rates of 47% and 29%, while the median OS was 24 months (95% CI; 8.6 - 39.3) with 1- and 3-year survival rates of 51% and 30%. A significantly better median PFS was observed in the metastatic versus local recurrence group (35 vs. 8 months, p=0.01). Similarly, a median OS of 41 months was observed in the metastatic group compared to only 12 months for the local recurrence group (p=0.12). Overall, a better survival time of 30 months was observed in the metachronous group compared to 6 months in the synchronous group (p=0.046). In a further analysis of the metastatic group, metachronous oligometastasis was associated with a longer survival of 43 months compared to 9 months for synchronous metastasis (p=0.18). Some differences were not significant, which may be due to sample size., Conclusion: Our study shows reasonable surgical and survival outcomes of metastasectomy, especially in the metachronous subgroup, for UC without risk of higher perioperative morbidity. On the other hand, resection of local recurrence is associated with a higher risk of incomplete resection and higher intraoperative and postoperative morbidity without offering a survival benefit., (S. Karger AG, Basel.)

Background: Renal cell carcinoma is one of the most common malignant tumors in Germany with an increasing incidence. Drug therapy is indicated in relapsed or metastatic disease., Materials and Methods: The article is based on the content of the recent guidelines and a selective literature search., Results: Combination therapies based on a checkpoint inhibitor are the current standard in first-line treatment of metastatic renal cell carcinoma. The median overall survival could thus be extended to > 50 months. The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score is used for risk classification. When selecting a suitable combination therapy, it is important to consider the advantages and disadvantages for each individual patient. There is currently no standard for follow-up therapies. So far, combination therapies have not shown any significant advantage in second-line treatment. It is recommended to switch to a substance that has not yet been used., Conclusions: Currently, one purely immuno-oncology combination and four combinations of one immune checkpoint inhibitor and one tyrosine kinase inhibitor (TKI) are approved for first-line therapy in Germany. The added value of further intensification of therapy, in particular through triple combinations or further combination therapy in the second line, has not yet been proven., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: T. Hilser: Honorar: IPSEN. C. Darr: Honorar: Janssen-Cilag, Ipsen; Reisekosten: Janssen-Cilag, Ipsen, Bayer. K. Schlack: Beratungstätigkeit: AAA, Amgen, Apogepha, Astellas, AstraZeneca, Bayer, BMS (personal and institutional), Eisai, EUSA-Pharma, Fosanis, Ipsen, Janssen Cilag, Merck Healthcare, MSD, Novartis (personal and institutional), Pfizer (personal and institutional), Roche; Reisekosten: Sanofi-Aventis, Astra Zeneca, Astellas, Bayer, Janssen Cilag, Ipsen, Merck Healthcare. V. Grünwald: Aktienbesitz: AstraZeneca, Bicycle Therapeutics, Bristol-Myers Squibb, Genmab, MSD; Honorar: Advanced Accelerator Applications/Novartis, Amgen, Apogepha, Astellas Pharma, AstraZeneca, Bristol-Myers Squibb, Eisai, Ipsen, Janssen-Cilag, Merck Serono, MSD Oncology, Ono Pharmaceutical, Pfizer; Beratungstätigkeit: Bristol-Myers Squibb, Cureteq, Debiopharm Group, Eisai, Gilead Sciences, Ipsen, Janssen-Cilag, MSD Oncology, Novartis, Oncorena, PCI Biotech, Pfizer, Synthekine; Forschungsfinanzierung: Amgen (Inst), Bicycle Therapeutics (Inst), Bristol-Myers Squibb (Inst), Gilead Sciences (Inst), Ipsen (Inst), Seagen (Inst); Reisekosten: AstraZeneca, Ipsen, Janssen, Merck Serono, Pfizer. U.-U. Yesilyurt und N. Klümper geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)