Early Bone Metastases are Associated with Worse Outcomes in Metastatic Urothelial Carcinoma

Ariel A. Nelson, Robert J. Cronk, Emily A. Lemke, Aniko Szabo, Ali R. Khaki, Leonidas N. Diamantopoulos, Petros Grivas, Behtash Ghazi Nezami, Gregory T. MacLennan, Tian Zhang, Christopher J. Hoimes

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


BACKGROUND: Outcomes of patients with metastatic urothelial carcinoma (mUC) with early bone metastases (eBM) vs no early bone metastases (nBM) have not thoroughly been described in the age of immuno-oncology. OBJECTIVE: To compare survival and other clinical outcomes in patients with eBM and nBM. METHODS: We used a multi-institutional database of patients with mUC treated with systemic therapy. Demographic, metastatic site, treatment patterns, and clinical outcomes were recorded. Wilcoxon rank-sum, chi-square tests were performed. Survival was estimated by Kaplan-Meier method; multivariable Cox analysis was performed. RESULTS: We identified 270 pts, 67% men, mean age 69±11 years. At metastatic diagnosis, 27% had≥1 eBM and were more likely to have de novo vs. recurrent metastases (42% vs 19%, p < 0.001). Patients with eBM had shorter overall survival (OS) vs. those with nBM, (6.1 vs 13.7 months, p < 0.0001). On multivariable analysis, eBM independently associated with higher risk of death, HR = 2.52 (95% CI: 1.75-3.63, p < 0.0001). OS was shorter for patients with eBM who received initial immune checkpoint inhibitor vs platinum-based chemotherapy, (1.6 vs 9.1 months, p = 0.02). Patients with eBM received higher opioid analgesic doses compared to patients with nBM and received quantitatively more palliative radiation. CONCLUSIONS: Patients with mUC and eBM have poorer outcomes, may benefit less from anti-PD-1/PD-L1 therapy and represent an unmet need for novel therapeutic interventions. Dedicated clinical trials, biomarker validation to assist in patient selection, as well as consensus on reporting of non-measurable disease are required.

Original languageEnglish (US)
Pages (from-to)33-42
Number of pages10
JournalBladder Cancer
Issue number1
StatePublished - 2021
Externally publishedYes


  • Bladder cancer
  • bone
  • immunotherapy
  • metastases
  • palliative care
  • urothelial cancer

ASJC Scopus subject areas

  • Oncology
  • Urology


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