Prognosis of patients with metastatic renal cell carcinoma and pancreatic metastases

Abstract

Objectives To identify the clinical outcomes of mRCC patients with PM treated with either pazopanib or sunitinib and assess whether PM is an independent prognostic variable in the current therapeutic environment. Patients and Methods Retrospective review of mRCC patients in an outpatient clinic was done from January 2006 to November 2011. Patient characteristics including demographics, laboratory data, and outcomes were analyzed. Comparison of baseline characteristics was done using chi2 and t-test and Overall Survival (OS) and Cancer-Specific Survival (CSS) was estimated using Kaplan-Meier methods. Predictors of OS were analyzed using Cox regression. Results A total of 228 patients were reviewed of which 44 (19.3%) had metastases to the pancreas and 184 (81.7%) had metastasis to sites other than the pancreas. The distribution of baseline characteristics was equal in both groups with the exception of a higher incidence of prior nephrectomy, diabetes and number of metastatic sites in the pancreatic metastasis group. 4 patients had isolated metastases to the pancreas, however, the majority of patients (68%) with pancreatic metastases had at least three different organ sites of metastases, as compared to 29% in patients without pancreatic metastases (p<0.01). Distribution of organ sites of metastases was similar (p>0.05), excluding pancreas. Median OS was 39 months (95% confidence interval [CI], 24–57, HR=0.66, 95% CI = 0.42–0.94, p=0.02) for patients with pancreatic metastases, compared to 26 months (95% CI, 21–31) for patients without pancreatic metastases (p-value <0.01). CSS was 42 months (95% CI: 30–57 months) in the PM group and 27 months (95% CI: 22–33 months, p-value = 0.05) in the control group. Conclusions Despite a higher number of affected organ sites in the pancreatic metastasis cohort, mRCC behavior in this cohort appears to be more indolent, as demonstrated by a higher median OS. These findings suggest that host or tumor features associated with pancreatic metastases may represent a less aggressive tumor phenotype.

Site of extranodal metastasis impacts survival in patients with testicular germ cell tumors

“…The distribution of metastatic involvement has been shown to carry prognostic value in several malignancies . The tendency of a tumor to metastasize to a particular organ site may reflect an interplay between the underlying biology of the tumor cells and a permissive host organ microenvironment .…”

Pancreatic tropism of metastatic renal cell carcinoma

“…What makes PM tropism particularly interesting is that when metastasizing to the pancreas, ccRCC is associated with better outcomes in patients, and this is the case even when other metastatic sites are involved (6,(12)(13)(14)(15)(16)(17). However, whether the improved prognosis can be accounted for by validated prognostic models, such as the international metastatic database consortium (IMDC), is not known.…”

Inoperable Pancreatic Metastasis of Renal Cell Carcinoma: A Case Report and a Review of Literature

“…Data suggests that RCC with pancreatic metastasis have a better outcome than lymph nodes, liver or cerebral metastasis [11] [12]. The overall survival rates are 80.6% and 72.6% at 2 and 5 years for resected patients versus 41 and 14% respectively in unresected patients [13].…”