Efficacy of Metastasectomy for Metastatic Bladder Cancer: A Systematic Review and Meta-Analysis.

Abstract

<h4>Objectives</h4>It has been proposed that metastasectomy may cure some patients with a single metastasis. Hence, we considered it necessary to clarify the role of metastasectomy for metastatic bladder cancer (BCa).<h4>Methods</h4>We conducted a systematic review of published reports on the efficacy of metastasectomy for different sites of BCa metastasis. We searched English articles published before 7 June 2025 in three electronic databases: PubMed, Embase, and Cochrane Library. We then extracted authors, year of publication, country in which the study was conducted, study institution, study design, survival analysis, months of follow-up, size of study cohort, treatment, hazard ratios (HR) with 95% confidence interval (CI), and source of HR. The Newcastle-Ottawa Scale was used to analyze the risk and quality of included studies. All procedures were performed according to the PRISMA guidelines. A meta-analysis was performed on studies with sufficient survival data to analyze. Overall survival was analyzed to clarify the efficacy of metastasectomy for metastatic BCa.<h4>Results</h4>Our meta-analysis identified 8 of 7877 articles published from 1992 to 2024 that met our criteria. These articles encompassed 15 139 patients in all, which showed that patients who underwent metastasectomy had better overall survivals (OS) than did those who only had non-surgical treatment (HR = 0.46, 95% CI 0.27-0.79, I² = 64.3%). Additionally, we found a positive association between OS and metastasectomy in patients with brain metastases (HR = 0.49, 95% CI 0.34-0.70, I² = 49.7%).<h4>Conclusions</h4>We found a positive association between metastasectomy and OS in patients with metastatic BCa, especially those with brain metastases. Metastasectomy should be considered an adequate approach in BCa, when feasible.<h4>Trial registration</h4>PROSPERO number: CRD42021234305.