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

Authors

  • Fredrik Liedberg Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Gediminas Baseckas Department of Urology, Skåne University Hospital, Malmö, Sweden
  • Mats Bläckberg Department of Urology, Helsingborg County Hospital, Helsingborg, Sweden
  • Ragna Fridriksdottir Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Department of Translational Medicine, Lund University, Malmö, Sweden
  • Axel Gerdtsson Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Oskar Hagberg Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Sofia Kjellström Department of Oncology, Skåne University Hospital, Malmö, Sweden
  • Petter Kollberg Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Ioannis Patras Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Elin Ståhl Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Olof Ståhl Department of Oncology, Skåne University Hospital, Malmö, Sweden
  • Anne Sörenby Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Elin Trägårdh Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Department of Translational Medicine, Lund University, Malmö, Sweden
  • Åsa Warnolf Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Johannes Bobjer Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden

DOI:

https://doi.org/10.2340/sju.v60.44649

Keywords:

Bladder cancer, oligometastatic, curative intent, survival

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, 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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Published

2025-09-03

How to Cite

Liedberg, F., Baseckas, G., Bläckberg, M., Fridriksdottir, R., Gerdtsson, A., Hagberg, O., … Bobjer, J. (2025). Survival patterns after perioperative treatment escalation and cystectomy for synchronous oligometastatic bladder cancer (M1a/M1b) – a population-based series. Scandinavian Journal of Urology, 60, 173–179. https://doi.org/10.2340/sju.v60.44649

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Vol. 60 (2025)

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Copyright (c) 2025 Fredrik Liedberg, Gediminas Baseckas, Mats Bläckberg, Ragna Fridriksdottir, Axel Gerdtsson, Oskar Hagberg, Sofia Kjellström, Petter Kollberg, Ioannis Patras, Elin Ståhl, Olof Ståhl, Anne Sörenby, Elin Trägårdh, Åsa Warnolf, Johannes Bobjer

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As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY license, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work. 

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