Impact of surgical resection of bladder cancer metastases refractory to systemic therapy on performance score: a phase II trial.
OBJECTIVE
To assess the outcome of complete surgical removal of metastases from bladder cancer with regard to survival, performance score, and tumor-related symptoms in a prospective Phase II trial.


METHODS
Between 1995 and 1999, 70 patients (52 men and 18 women) with a median age of 64 years (range 30 to 88) were treated with complete surgical resection of bladder cancer metastases. Patients with asymptomatic (n = 19) and symptomatic (n = 51) secondary cancer from bladder cancer refractory to methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) therapy were included. We removed secondary cancer metastatic to the lymph nodes, peritoneum, skin, bone, lung, and liver and measured the survival, performance score, and tumor-related and therapy-related symptoms.


RESULTS
The median survival time was 7 months. With a 1-year survival rate of 30% and a 2-year survival rate of 19%, the prognosis is unfavorable, independent of the site of metastasis. Patients who were asymptomatic complained of a reduced sense of well-being postoperatively (P = 0.007). However, 42 (83%) of the 51 patients with symptomatic secondary cancer did benefit from surgery in terms of tumor-related symptoms and performance score. The World Health Organization performance score changed from 3.3 to 2.1 (P = 0.005).


CONCLUSIONS
Surgical removal of metastases from bladder cancer refractory to systemic therapy has an impact on the quality of life of patients with symptomatic disease only. Asymptomatic patients felt worse after surgery and no survival advantage appeared to be gained.
Otto
T
T
West German Comprehensive Cancer Center and Department of Urology, University of Essen Medical School, Essen, Germany.
Krege
S
S
Suhr
J
J
Rübben
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000556:secondary / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D002945:Cisplatin / Q000008:administration & dosage; D015653:Cystectomy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery; D008197:Lymph Node Excision; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000556:secondary / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D014747:Vinblastine / Q000008:administration & dosage
D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate