Nephrectomy in Renal Carcinoma with Distant Metastasis

Abstract

A total of 96 cases of renal carcinoma with distant metastasis at the time of diagnosis was studied. The patients were classified into 4 groups: Group O (16) in whom nephrectomy was not performed, Group A (51) who died due to carcinoma within 1 year of nephrectomy, Group B (25) who died due to carcinoma 1 to 3 years after nephrectomy, and Group C (4) who survived for 3 years or more after nephrectomy. Six clinical measurements were evaluated: haemoglobin, ESR, alpha 2 globulin, temperature, weight and C reactive protein. In addition, performance status, the number of organs with metastases, number of metastatic lesions and tumour growth rate were measured. The results showed that in patients surviving for 1 year or more after nephrectomy, there was an abnormality in the results of 3 or less of the 6 clinical measurements, performance was 0 or 1, and the carcinoma had metastasised to only one organ. In addition, it was found that the growth of metastatic lesions in patients who survived for 3 years or more was much slower than in the other patients. Nephrectomy was found to be effective in only 27% of our cases and we consider that careful deliberation should be made pre-operatively as to whether nephrectomy is really necessary in patients with metastasis. The decision should be made on the basis of the results obtained in the 6 clinical measurements given above.

Pre-Operatively Determined Prognostic Factors in Metastatic Renal Cell Carcinoma

“…We have reported that RCC cells produce interleukin-6 and that elevation of the serum level of interleukin-6 is signifi cantly related to survival of patients with RCC without metastasis, while the serum level of interleukin-6 does not directly correlate to tumor volume and tumor grade [5]. Onishi et al [15] reported supportive results, indicating that short-term survivals were noted in patients with met astatic RCC showing elevation of acute-phase proteins.…”

Prognostic evaluation of transcatheter arterial embolization for unresectable renal cell carcinoma with distant metastasis

“…However, there have been reports indicating that, among patients with an acceptable performance status, those who underwent nephrectomy survived significantly longer than those who did not [9]. In predicting the outcome in patients with advanced RCC, favourable factors include a good performance status, single‐organ metastasis, lower tumour grade, lower T stage and two or fewer of the six clinical measurements (anaemia, high ESR, α‐2 globulin increase, fever of unknown origin, weight loss and a positive reaction to CRP) [10,11]. There are many patients who are unable to undergo nephrectomy because of adverse factors and the prognosis in these patients is unfavourable even if treated with interferon or interleukin‐2.…”

“…There were no significant background differences between the present groups except for the proportion of patients who showed para‐neoplastic signs, where significantly more patients in the TAE group had such signs. As these para‐neoplastic signs are accepted as important prognostic factors [9,11] we suggest that the therapeutic effect of TAE is not only on the primary lesion but also has general effects in such high‐risk patients, e.g. immunological reactions against the tumour might be induced in the host [16].…”

Metachronous solitary metastasis of renal cell carcinoma to the contralateral adrenal gland after nephrectomy

“…1,2 After nephrectomy, 20% to 50% of patients show recurrence, 3,4 and fewer than 5% of those with metastatic disease are alive at 5 years. The lungs (50%), bones (49%), lymph nodes (6%-32%), skin (11%), liver (8%), and brain (3%) are the most frequent sites of clinical metastases.…”