Stage IV Renal Cell Carcinoma

Frank, Walter L.; Stuhldreher, David; Saffrin, Robert; Shott, Susan; Guinan, Patrick

doi:10.1016/s0022-5347(17)32289-9

Cited by 23 publications

(13 citation statements)

References 10 publications

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“…In general, the location of the systemic disease is considered to have prognostic relevance since patients with metastases to the lungs tend to have better survival than patients with bony metastases. 12 Our results are contrary to the assumption that an extraspinal disease location affects outcome given that we found no difference in survival after spinal surgery in patients with metastatic deposits in the lungs versus nonspinal bone versus visceral organs including the brain.…”

Section: Discussioncontrasting

confidence: 99%

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Factors affecting survival in 267 consecutive patients undergoing surgery for spinal metastasis from renal cell carcinoma

Tatsui

Suki

Rao

et al. 2014

SPI

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Object Renal cell carcinoma (RCC) frequently metastasizes to the spine, and the prognosis can be quite variable. Surgical removal of the tumor with spinal reconstruction has been a mainstay of palliative treatment. The ability to predict prognosis is valuable when determining the role and magnitude of surgical intervention in cancer patients. To better identify factors affecting survival in patients undergoing surgery for spinal metastasis from RCC, the authors undertook a retrospective analysis of a large patient cohort at a tertiary care cancer center. Methods Relevant clinical data on a consecutive series of patients who had undergone surgery for spinal metastasis of RCC between 1993 and 2007 at The University of Texas MD Anderson Cancer Center were retrospectively reviewed. Demographic data, histopathological grade of primary tumor, timing of spinal surgery relative to diagnosis, treatment history prior to surgery, neurological status, and systemic disease burden were analyzed to determine the impact of these factors on survival outcome. Results The authors identified 267 patients who met the study criteria. Five-year overall survival (OS) after spine tumor resection was 7.8%, with a median OS of 11.3 months (95% CI 9.5–13.0 months). Patients with Fuhrman Grade 4 RCC had a median OS of 6.1 months (95% CI 3.5–8.7 months), which was significantly lower than the 14.3 months (95% CI 9.1–19.4 months) observed in patients with Fuhrman Grade 3 or less RCC (p < 0.001). Patients with preoperative neurological deficits had a median survival of 5.9 months (95% CI 4.1–7.7 months), which was significantly lower than the 13.5 months (95% CI 10.4–16.6 months) observed in patients with a normal neurological examination (p < 0.001). Patients whose spine was the only site of metastasis had a median OS of 19 months (95% CI 9.8–28.2 months) after surgery, significantly longer than the 9.7 months (95% CI 8.1–11.3 months) observed in patients with additional extraspinal metastasis sites (p < 0.001). Patients with nonprogressing extraspinal metastasis (no metastasis, stable, or concurrent) had a median survival of 20.6 months (95% CI 15.1–26.1 months), compared with 5.6 months (95% CI 4.4–6.8 months) in patients with progressing metastasis (p < 0.001). Conclusions The authors identified several factors influencing survival after spine surgery for metastatic spinal RCC, including grade of the original nephrectomy specimen, activity of the systemic disease, and neurological status at the time of surgery. These clinical features may help to identify patients who may benefit from aggressive surgical intervention.

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Section: Discussioncontrasting

confidence: 99%

“…12,18,28,31 Series that focus on metastasis to nodes, 3 lung, 35 and bone 2,29,43 have documented longer survival after surgical treatment of oligometastatic disease. This finding holds true in our analysis.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting survival in 267 consecutive patients undergoing surgery for spinal metastasis from renal cell carcinoma

Tatsui

Suki

Rao

et al. 2014

SPI

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“…Among stage IV tumors, no clinical parameters have been identified that predict improved survival (15). Other groups have reported microarray profiles for RCC.…”

Section: Discussionmentioning

confidence: 99%

Predicting survival in patients with metastatic kidney cancer by gene-expression profiling in the primary tumor

Vasselli

Shih

Iyengar

et al. 2003

Proc. Natl. Acad. Sci. U.S.A.

160

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To identify potential molecular determinants of tumor biology and possible clinical outcomes, global gene-expression patterns were analyzed in the primary tumors of patients with metastatic renal cell cancer by using cDNA microarrays. We used grossly dissected tumor masses that included tumor, blood vessels, connective tissue, and infiltrating immune cells to obtain a gene-expression "profile" from each primary tumor. Two patterns of gene expression were found within this uniformly staged patient population, which correlated with a significant difference in overall survival between the two patient groups. Subsets of genes most significantly associated with survival were defined, and vascular cell adhesion molecule-1 (VCAM-1) was the gene most predictive for survival. Therefore, despite the complex biological nature of metastatic cancer, basic clinical behavior as defined by survival may be determined by the gene-expression patterns expressed within the compilation of primary gross tumor cells. We conclude that survival in patients with metastatic renal cell cancer can be correlated with the expression of various genes based solely on the expression profile in the primary kidney tumor.

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“…These factors may help us to select patients for whom nephrectomy may be beneficial. Many prognos tic factors such as performance status [9][10][11], tumor size [3], tumor grade [11], gender [12,13] and site or number The group with métastasés to multiple organs had the poorest prognosis (p = 0.015; group with single metastatic focus in a single organ vs. group with multiple-organ métastasés.…”

Section: Discussionmentioning

confidence: 99%

“…The role of surgical excision of the primary site (palliative nephrectomy) is still controver sial for those patients. Some reports indicated that ne phrectomy could improve the prognosis of metastatic RCC in selected patients [1][2][3]. However, nephrectomy is not always beneficial for all such patients because some die of metastatic disease within a year of the operation.…”

Section: Introductionmentioning

confidence: 99%

Pre-Operatively Determined Prognostic Factors in Metastatic Renal Cell Carcinoma

Miyao

Oda²,

Shigyou³

et al. 1997

Eur Urol

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Stage IV Renal Cell Carcinoma

Cited by 23 publications

References 10 publications

Factors affecting survival in 267 consecutive patients undergoing surgery for spinal metastasis from renal cell carcinoma

Factors affecting survival in 267 consecutive patients undergoing surgery for spinal metastasis from renal cell carcinoma

Predicting survival in patients with metastatic kidney cancer by gene-expression profiling in the primary tumor

Pre-Operatively Determined Prognostic Factors in Metastatic Renal Cell Carcinoma

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