PATTERN OF METASTASES IN RELATION TO CHARACTERISTICS OF PRIMARY TUMORAND TREATMENT IN PATIENTS WITH DISSEMINATED UROTHELIAL CARCINOMA

Purpose: The anatomical pattern of recurrence and metastases in patien ts with urothelial cancer are described, and the relationship between treatment and features of the primary invasive tumor and the subsequen t pattern of metastases is analyzed. Materials and Methods: Between 19 76 and 1991, 240 patients with recurrent or metastatic urothelial canc er were admitted to our department. Results: The majority of the patie nts had recurrence within 2 years after initial diagnosis. Local recur rences and lung metastases were diagnosed significantly earlier than o ther metastases. Multiple sites were involved in more than half of the patients. The most common sites of recurrence were local in the bladd er in 65% of the cases and bone in 35%, followed by lymph nodes in 26% and lung in 20%. The pattern of metastases was similar in patients wi th different histological findings, grade and location of the primary tumor. Patients younger than 60 years and those with cancer of the ren al pelvis more often had distant metastases compared to older patients with bladder cancer. Local recurrences were less frequent in patients who had undergone cystectomy compared to those treated with radiother apy only. Moreover, patients with local recurrences were likely to hav e metastases elsewhere. Conclusions: Bone was the most frequent site o f metastases outside the pelvis and all patients suspected to have rec urrence should be examined for bone metastases. The results indicate t hat the pattern of recurrence and metastases are not dependent on the features of the primary tumor.