The Challenges of Renal Cell Carcinoma Metastatic to the Spine: A Systematic Review of Survival and Treatment

Abstract

Study Design:Systematic review.Objectives:The objective of this systematic review was to answer 2 key questions: (1) What is the clinical presentation and probability of symptomatic improvement following treatment for patients with renal cell carcinoma (RCC) of the spine? (2) What is the overall survival of patients diagnosed with spinal metastases from RCC?Methods:A literature review was performed to identify articles that reported on survival, clinical outcomes, and/or prognostic factors in the RCC population with spinal metastases from 1986 to 2016.Results:Forty-eight articles (807 patients) were included. The Fuhrman Nuclear Grade has been significantly associated with survival in previous studies but was underpowered in the current study. The Memorial Sloan-Kettering Cancer Center Score (MSKCC/Motzer) was also underpowered in the current study. From the time of spinal metastasis, the mean and median survival for patients with previously diagnosed primary RCC was 8.75 and 11.7 months, respectively, whereas synchronously diagnosed patients (primary RCC and spinal metastasis) had a mean and median survival of 6.75 and 11 months, respectively. Patients with a “low” (0-8), “intermediate” (9-11), or “high” (12-15) revised Tokuhashi score at initial presentation had a median survival of 5.4, 11.7, and 32.9 months, respectively.Conclusion:Patients with either a synchronous or latent diagnosis of RCC survived greater than 6 months from the time of presentation. Initial Furhman grade, Tokuhashi score, and MSKCC/Motzer can be useful tools in informing patient-specific prognosis for those with metastatic RCC of the spine.

Predicting tumor-specific survival in patients with spinal metastatic renal cell carcinoma: which scoring system is most accurate?

“…We expect the median survival of prognostic classes to change in the future as the armamentarium of systemic therapies (TKIs, mTOR inhibitors, checkpoint blockade immunotherapies, combinations, and novel strategies) for advanced cases of RCC expands. 34,35 Novel neoadjuvant and adjuvant therapies such as targeted therapy and radiosurgery are not part of any of the prognostic scores for spinal metastasis and therefore are not weighted when estimating survival despite their well-established effect on survival. In this regard, these scoring systems do not reflect the underlying molecular and genetic makeup of RCC; they particularly do not consider treatment responses to systemic therapies and radiosurgery.…”

Unilateral fixation utilizing minimally invasive surgery (MIS) system for lumbosacral metastasis in a patient with stage 4 renal cell carcinoma

“…Renal cell carcinoma (RCC) is the fourth most common type of spinal metastatic tumor following lung, breast, and prostate [4] . About one third of patients with RCC are diagnosed with metastatic disease at presentation [17] and 25% of RCC recur locally or as metastatic disease even after nephrectomy [18] . Although there are reports of long overall survival in the setting isolated RCC spinal metastases [15] , [16] , Goodwin reported the mean and median survival to be 6.75 and 7 months from the time of presentation for patients who initially present with multiple metastases accompanied with spinal metastases from RCC [19] .…”

Evolution of Surgical Treatment of Metastatic Spine Tumors.

“…68,69 Patients with RCC spinal metastases have wide range in reported survival that re ects patient Tokuhashi scores, from 5-32.9 months, according to one recent review. 70 Currently, nivolumab (PD-1 inhibitor) with or without ipilimumab (CTLA-4 targeted therapy) is the most commonly studied treatment regimen, [71][72][73] with vascular endothelial growth factor receptor (VEGFR) TKIs and mammalian target of rapamycin (mTOR) inhibitors for additional targeted therapy. 69,74 Future studies are needed to determine the optimal combination of drugs and their timing in order to minimize side effects.…”