Survival after complete surgical resection of multiple metastases from renal cell carcinoma

Abstract

BACKGROUND: Although a role for resection of solitary metastases from renal cell carcinoma (RCC) has been described, the utility of surgery in patients with multiple sites of disease has been less well defined. The authors report the survival of patients who underwent complete metastasectomy for multiple RCC metastases. METHODS: The authors identified 887 patients who underwent nephrectomy for RCC between 1976 and 2006 who developed multiple metastatic lesions. The impact of complete metastasectomy on survival was evaluated controlling for the timing, location, and number of metastases and for patient performance status. RESULTS: Of 887 patients, 125 (14%) underwent complete surgical resection of all metastases. Complete metastasectomy was associated with a significant prolongation of median cancer-specific survival (CSS) (4.8 years vs 1.3 years; P < .001). Patients who had lung-only metastases had a 5-year CSS rate of 73.6% with complete resection versus 19% without complete resection (P < .001). A survival advantage from complete metastasectomy also was observed among patients with multiple, nonlung-only metastases, who had a 5-year CSS rate of 32.5% with complete resection versus 12.4% without complete resection (P < .001). Complete resection remained predictive of improved CSS for patients who had 3 metastatic lesions (P < .001) and for patients who had synchronous (P < .001) and asynchronous (P ¼ .002) multiple metastases. Moreover, on multivariate analysis, the absence of complete metastasectomy was associated significantly with an increased risk of death from RCC (hazard ratio, 2.91; 95% confidence interval, 2.17-3.90; P < .001). CONCLUSIONS: The current results indicated that complete resection of multiple RCC metastases may be associated with longterm survival and should be considered when technically feasible in appropriate surgical candidates. Cancer 2011;117:2873-

Differential gene expression profiling of matched primary renal cell carcinoma and metastases reveals upregulation of extracellular matrix genes

“…We also acknowledge that there are biological differences between subjects with distant metastases who undergo metastasectomy and subjects ineligible for metastasectomy. Patients with high-volume disease, rapid progression or poor performance status are less likely to undergo metastasectomy [35,36]. Conversely, the presence of pancreatic metastases in RCC is associated with a more indolent clinical course [37].…”

Local treatments for metastases of renal cell carcinoma: a systematic review

“…All studies were retrospective and non-randomised, leading to the high risk of bias associated with non-randomisation, patient attrition, and selective reporting. With the exception of one study, 12 all studies were substantially underpowered. Regarding confounding, about half of studies reported adequate data on age and sex.…”

“…No randomised controlled trials or prospective non-randomised comparative studies were identifi ed. Eight studies assessed local treatments of metastases from renal cell carcinoma in various organs, 12,24,26,27,[29][30][31][32] of which the most common sites were lung, bone, liver, and brain, and less common sites were pancreas, adrenal gland, lymph nodes, thyroid gland, spleen, ethmoid sinus, and skin (table 1). Other studies also assessed local treatments for metastases from renal cell carcinoma in bone (including the vertebrae), 33 29 used treatment beforehand.…”

“…All of the eight studies 12,24,26,27,[29][30][31][32] that assessed metastases from renal cell carcinoma in various organs reported on complete metastasectomy versus no metastasectomy, incomplete metastasectomy, or both (table 2). However, in one study, 32 complete resection was achieved in only 45% of the metastasectomy group, which was compared with patients with no metastasectomy.…”

“…10,11 Surgical resection is a possible treatment for these metastases, but metastases' accessibility and resectability, and patients' performance and comorbidities have to be taken into account. 12 Radiotherapy modalities can provide valid local noninvasive treatment alternatives to surgery. For brain metastases, these include whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS).…”