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Survival patterns after perioperative treatment escalation and cystectomy for synchronous oligometastatic bladder cancer (M1a/M1b) – a population-based series

Liedberg, Fredrik LU ; Baseckas, Gediminas ; Bläckberg, Mats LU ; Fridriksdottir, Ragna ; Gerdtsson, Axel LU ; Hagberg, Oskar LU ; Kjellström, Sofia ; Kollberg, Petter LU ; Patras, Ioannis LU orcid and Ståhl, Elin LU , et al. (2025) In Scandinavian Journal of Urology 60. p.173-179
Abstract

Background: The role of cystectomy in synchronous oligometastatic bladder cancer is unclear. Objective: To describe a population-based consecutive cohort with primary oligometastatic bladder cancer (M1a or M1b) treated with curative intent. Methods: Twenty consecutive patients with primary stage M1a or M1b bladder cancer subjected to induction chemotherapy and radical cystectomy 2013–2024 in the Southern healthcare region were identified in the Swedish National Register for Urinary Bladder Cancer. Primary staging and the evaluation of response to systemic induction chemotherapy were performed using [18F]fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET-CT). After additional chemotherapy,... (More)

Background: The role of cystectomy in synchronous oligometastatic bladder cancer is unclear. Objective: To describe a population-based consecutive cohort with primary oligometastatic bladder cancer (M1a or M1b) treated with curative intent. Methods: Twenty consecutive patients with primary stage M1a or M1b bladder cancer subjected to induction chemotherapy and radical cystectomy 2013–2024 in the Southern healthcare region were identified in the Swedish National Register for Urinary Bladder Cancer. Primary staging and the evaluation of response to systemic induction chemotherapy were performed using [18F]fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET-CT). After additional chemotherapy, consolidating radical cystectomy, lymphadenectomy and in selected patients, postoperative stereotactic radiotherapy or adjuvant nivolumab were applied. Disease-free survival (DFS) and overall survival (OS) from chemotherapy start were visualised by Kaplan-Meier curves. Results: Ten patients with retroperitoneal lymph node metastases, seven with single bone metastasis and three with inguinal metastases responding on three chemotherapy courses according to FDG PET-CT-evaluations were subjected to additional chemotherapy and subsequent radical cystectomy and lymphadenectomy with templates including lymph node metastases. Five patients with bone-oligometastatic disease received consolidating stereotactic radiotherapy, and three patients received adjuvant nivolumab. Postoperatively, one patient progressed in preoperatively known bone metastasis, and one patient displayed lack of chemotherapy response in the cystectomy specimen and was consequently subjected to second-line pembrolizumab treatment with palliative intent. At a median follow-up of 23 months, 10 patients (50%) were disease-free. Conclusions: Long-term survival was observed in some individuals after multimodal treatment for selected patients with synchronous oligometastatic bladder cancer. Patient summary: Amongst patients diagnosed with limited number of distant bladder cancer metastases, those responding on initial systemic chemotherapy can be selected for further treatment. After additional chemotherapy, radical cystectomy with lymphadenectomy and individually intensified treatment with consolidating radiation towards distant metastases and/or adjuvant systemic treatment with checkpoint inhibitors for 12 months, long-term survival was observed in some individuals despite a disease-entity with bad prognostic features.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bladder cancer, curative intent, oligometastatic, survival
in
Scandinavian Journal of Urology
volume
60
pages
7 pages
publisher
Taylor & Francis
external identifiers
  • pmid:40899808
  • scopus:105015747467
ISSN
2168-1805
DOI
10.2340/sju.v60.44649
language
English
LU publication?
yes
id
ad4efec7-096b-4c5f-9d30-78779bc819bb
date added to LUP
2025-11-12 12:44:00
date last changed
2025-11-26 14:03:26
@article{ad4efec7-096b-4c5f-9d30-78779bc819bb,
  abstract     = {{<p>Background: The role of cystectomy in synchronous oligometastatic bladder cancer is unclear. Objective: To describe a population-based consecutive cohort with primary oligometastatic bladder cancer (M1a or M1b) treated with curative intent. Methods: Twenty consecutive patients with primary stage M1a or M1b bladder cancer subjected to induction chemotherapy and radical cystectomy 2013–2024 in the Southern healthcare region were identified in the Swedish National Register for Urinary Bladder Cancer. Primary staging and the evaluation of response to systemic induction chemotherapy were performed using [<sup>18</sup>F]fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET-CT). After additional chemotherapy, consolidating radical cystectomy, lymphadenectomy and in selected patients, postoperative stereotactic radiotherapy or adjuvant nivolumab were applied. Disease-free survival (DFS) and overall survival (OS) from chemotherapy start were visualised by Kaplan-Meier curves. Results: Ten patients with retroperitoneal lymph node metastases, seven with single bone metastasis and three with inguinal metastases responding on three chemotherapy courses according to FDG PET-CT-evaluations were subjected to additional chemotherapy and subsequent radical cystectomy and lymphadenectomy with templates including lymph node metastases. Five patients with bone-oligometastatic disease received consolidating stereotactic radiotherapy, and three patients received adjuvant nivolumab. Postoperatively, one patient progressed in preoperatively known bone metastasis, and one patient displayed lack of chemotherapy response in the cystectomy specimen and was consequently subjected to second-line pembrolizumab treatment with palliative intent. At a median follow-up of 23 months, 10 patients (50%) were disease-free. Conclusions: Long-term survival was observed in some individuals after multimodal treatment for selected patients with synchronous oligometastatic bladder cancer. Patient summary: Amongst patients diagnosed with limited number of distant bladder cancer metastases, those responding on initial systemic chemotherapy can be selected for further treatment. After additional chemotherapy, radical cystectomy with lymphadenectomy and individually intensified treatment with consolidating radiation towards distant metastases and/or adjuvant systemic treatment with checkpoint inhibitors for 12 months, long-term survival was observed in some individuals despite a disease-entity with bad prognostic features.</p>}},
  author       = {{Liedberg, Fredrik and Baseckas, Gediminas and Bläckberg, Mats and Fridriksdottir, Ragna and Gerdtsson, Axel and Hagberg, Oskar and Kjellström, Sofia and Kollberg, Petter and Patras, Ioannis and Ståhl, Elin and Ståhl, Olof and Sörenby, Anne and Trägårdh, Elin and Warnolf, Åsa and Bobjer, Johannes}},
  issn         = {{2168-1805}},
  keywords     = {{Bladder cancer; curative intent; oligometastatic; survival}},
  language     = {{eng}},
  pages        = {{173--179}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Urology}},
  title        = {{Survival patterns after perioperative treatment escalation and cystectomy for synchronous oligometastatic bladder cancer (M1a/M1b) – a population-based series}},
  url          = {{http://dx.doi.org/10.2340/sju.v60.44649}},
  doi          = {{10.2340/sju.v60.44649}},
  volume       = {{60}},
  year         = {{2025}},
}