Pattern of metastases in renal cell carcinoma: A single institution study

Abstract

BACKGROUND:Increasing numbers of patients with renal cell carcinoma (RCC) are incidentally detected and can be potentially cured by surgery alone. In treating metastatic RCC, worthwhile survival rates are achieved in cases of low burden recurrences. This necessitates a rational follow up protocol, which picks up early recurrences and avoids costly surveillance for those with a favorable prognosis. AIMS: We studied the patterns of metastases occurring in patients operated for localized or locally advanced renal cell carcinoma in the Indian setting and tried to evolve a suitable follow up protocol. SETTING AND DESIGN: Institution-based, retrospective data. METHOD AND MATERIALS: Records of patients from January 1988 to December 2003, operated for initially localized RCC were reviewed. Follow up was performed using an established protocol. Occurrence of metastases and their patterns were studied. STATISTICAL ANALYSIS USED: Comparison of the different survival times was performed using the one-way analysis method. Multiple comparisons (post hoc test) were performed using the Bonferroni method.RESULT: Follow up was available on 209 patients. Mean survival was 43.75 months (SD + 28.72). Thirty-nine patients developed 59 metastases. Lungs were the commonest site of metastases (37%), followed by bone (22%), liver (19%), and brain (8%). Relapse and survival showed significant correlation with pathological stage (p < 0.001), with higher stage being associated with greater relapses and lesser survival. There was no correlation between site of recurrence and stage of disease. CONCLUSIONS: Occurrence of metastases correlate with the pathological stage of the disease at primary presentation. Tailored, stage-based follow up protocols allow adequate surveillance for disease activity and progression without escalating the overall costs.