Gastrointestinal Metastases From Primary Renal Cell Cancer: A Single Center Review

Abstract

Introduction: Digestive metastases (DMs) from renal cell cancer (RCC) are rare. Over the past decade, the overall survival of metastatic RCC (mRCC) has been improved by tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors. The main objective of this study was to assess the incidence of metastases of the digestive tract in this new field of treatment. The secondary objectives were to evaluate the clinical characteristics, prognosis, treatments used for DMs, and median time between the diagnosis of RCC or mRCC and DMs.Materials and Methods: A retrospective analysis of data collected from all patients with mRCC between 2007 (the time of TKI was a standard of care) and 2019 was carried out at the Paoli-Calmettes Institute (Marseille, France). Computer research software using artificial intelligence (ConSoRe®) was used to identify patients and assess their characteristics.Results: Between January 2007 and December 2019, 11 out of 660 (1.6%) mRCC patients had metastases of the gastrointestinal tract. The median age was 62 years. Of the 11 patients, 81.8% experienced digestive bleeding or anemia. Only 2 patients were asymptomatic. The metastases were mainly duodenal (50%) and gastric (41.6%). The median time from cancer diagnosis and from metastatic disease to gastrointestinal metastasis was 4.3 years (3 months−19.2 years) and 2.25 years (0 days−10.2 years), respectively. Local treatment was performed in 38.5% of cases by endoscopy (60%), surgery (20%) and radiotherapy (40%) with success rates of 33, 100, and 50%, respectively. Etiological treatment was modified following the discovery of DM in 84.6% of the cases. The median survival was 1 year from the diagnosis of DM (13 days−9.4 years). Two patients were still alive 2.9 and 9.4 years after the diagnosis of DM.Conclusion: This is the largest monocentric retrospective analysis of DM in patients with RCC. It seems to be a rare and late event in the course of the disease. Local treatment combined with systemic treatment could improve survival. In the context of prolonged survival with the new based immunotherapy treatments in mRCC, we suggest that unexplained anemia or persistent digestive symptoms could be explored by endoscopy.

Case report: Uncommon gastric metastasis as a presentation of recurrent clear cell renal cell carcinoma

“…Additionally, metastases to different parts of the gastrointestinal tract, such as the stomach, duodenum, or other regions, may present with varying clinical symptoms and timelines for detection ( 26 ). For instance, metastasis to the duodenum has been reported as occurring after 13 and 27 years ( 27 ), whereas gastric metastasis may have a latency period of 7 years ( 17 ).…”

“…Additionally, resection proves efficacious and prompt, especially when the metastasis induces acute bleeding. Furthermore, in scenarios involving multiple metastases, complete resection contributes to enhanced patient survival ( 17 , 34 ).…”

“…This represents a minority within the spectrum of malignant kidney tumors, accounting for less than 1% of cases ( 16 ). Among the various histological variants of RCC, around 30% of clear cell renal cell carcinoma (ccRCC) cases involve metastasis at the time of diagnosis, with the most commonly affected sites being the lungs (45.2%), bones (29.5%), lymph nodes (21.8%), and liver (20.3%) ( 17 ). Renal collecting duct renal cell carcinoma (CDCRCC) and papillary renal cell carcinoma (PRCC) generally carry a lower risk of metastasis, with metastatic occurrences primarily observed in distant organs such as the lungs (0.3%), bones (0.3%), liver (0.2%), and lymph nodes (97.6%) ( 18 , 19 ).…”

Application of 18F Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Monitoring Gastric Metastasis and Cancer Thrombi from Renal Cell Carcinoma

“…Endoscopic or surgical treatment can be used for single and early gastric metastasis [24]. Immunotherapy and/or targeted therapy can be used for multiple focal metastases or other organ metastases to improve patient survival [87][88][89][90]. e treatment of cancer thrombus requires a comprehensive evaluation and individualized therapy, including surgical resection, biological regulators, or targeted molecular therapy [87,91,92].…”

Small Bowel Perforation Due to Renal Carcinoma Metastasis: A Comprehensive Case Study and Literature Review

“…These explorations include enteroscopy, videocapsule endoscopy, or exploratory surgery combined with enteroscopy, owing to the challenges associated with their detection. [31]. Enteroscopy, performed via both oral and anal approaches, is recommended and should not be confined to the upper digestive tract [32].…”