The Natural History of Metastatic Renal Cell Carcinoma: A Computer Analysis

deKernion, Jean B.; Ramming, Kenneth P.; Smith, Robert B.

doi:10.1016/s0022-5347(17)57082-2

Cited by 495 publications

(180 citation statements)

References 9 publications

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“…Since the incidence of regression of metastases had been less than 1%, Middleton [20] calculated that the morbidity and mortality from nephrectomy in these patients are higher than the potential benefit and therefore concluded that nephrectomy for the sole purpose of achieving regression of metastases is not warranted in asymptomatic patients. The rnortality of adjunctive nephrectomy under these circumstances ranges from 2 to 15%; most of the authors report 5% [6,22,25].…”

Section: Discussionmentioning

confidence: 99%

Metastatic renal cell carcinoma (RCC): Spontaneous regression, long-term survival and late recurrence

Riese

Goldenberg

Allhoff

et al. 1991

International Urology and Nephrology

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We report 4 cases of metastatic renal cell carcinoma (RCC) with long-term survival either following radical nephrectomy alone or in combination with radioor hormonal therapy.Two patients with lymph node metastases showed a long-term survival of 12 or more years following radical tumour nephrectomy (with lymphadenectomy) and radiotherapy. One of them exhibited a histologically proven tumour recurrence nearly 12 years after pIimary surgical treatment and died shortly later; the other one is still without any evidence of metastatic disease.Two other patients exhibited spontaneous regression of pulmonary metastases: one regression occurred after radical tumour nephrectomy alone, the other one after successful primary hormonal treatment and subsequent radical tumour nephrectomy.The following important aspects are emphasized: 1. Renal cell carcinoma is a very unpredictable tumour. Once the diagnosis of renal cell carcinoma is proved, a patient can never be considered cured.2. Although adjuvant palliative nephrectomy has produced contradictory results in several reports, radical tumour nephrectomy either alone or in combination with other adjuvant therapies such as radiotherapy, hormonal or immunological treatment, can be worthwhile. Cases with long-term survival and spontaneous regression of distant metastases are proof of this. Besides, if carefully selected, the mortality rate of different adjuvant therapies is not significantly higher in patients with metastatic disease than in patients without metastases.The world literature on this subject is reviewed.

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Section: Discussionmentioning

confidence: 99%

Metastatic renal cell carcinoma (RCC): Spontaneous regression, long-term survival and late recurrence

Riese

Goldenberg

Allhoff

et al. 1991

International Urology and Nephrology

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“…14 Metastatic disease is seen in 25-40% of the cases at diagnosis, 15,16 with a 5-year survival rate of 13%. 17 Twenty years ago, the incidental case rate was less than 5%, but there has been an increase of more than 50% in early diagnosis up to the present day, due to the advent of non-invasive radiological techniques such as ultrasonography and computerized tomography (CT) scans. This has allowed small lesions with favorable prognosis and low incidence of metastasis to be discovered.…”

Section: Introductionmentioning

confidence: 99%

Incidental and symptomatic renal tumors: impact on patient survival

et al. 2002

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CONTEXT: Renal cell carcinoma is the third most frequent genitourinary neoplasia, and there is currently an increase in the incidental diagnosis of tumors confined to the kidneys. OBJECTIVE: To study the survival of patients with incidental and symptomatic renal tumors who have undergone nephrectomy.DESIGN: Retrospective. SETTING: Hospital Sírio Libanês and Beneficência Portuguesa de São Paulo. PARTICIPANTS: 115 patients with diagnosis of renal cell carcinoma, operated on by the same group of surgeons and evaluated by a single pathologist. MAIN MEASUREMENTS: Sex, age and diagnosis method, analyzed in two groups, according to the tumor diagnosis: Group 1 with incidental diagnosis and Group 2 with symptomatic tumors. The anatomopathological characteristics and patient survival in both groups were evaluated. A statistical analysis was performed using the Student t, chi-squared, log rank and Kaplan-Meyer tests. RESULTS: Among the studied patients, 59(51%) had an incidental diagnosis, with 78% diagnosed by ultrasonography, 20% by computerized tomography scan and 2% during surgeries; 56 patients (49%) were symptomatic. Tumor locations were equally distributed between the two kidneys, and the surgery was conservative for 24% of the incidental and 9% of the symptomatic group. In the incidental group only one patient had tumor progression and there was no death, while in the symptomatic group there were 5 progressions and 10 deaths. The 5-year specific cancer-free survival was 100% in the incidental and 80% in the symptomatic group (p = 0.001) while the disease-free rate was 98% in the incidental and 62% in the symptomatic group (p < 0001). CONCLUSION: Incidental renal tumor diagnosis offers better prognosis, providing longer disease-free survival.

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“…3 Furthermore, survival 3 years after the beginning of treatment is between 19% and 31%, 24 -29 5-18% being the survival of non-treated patients (Table VIII). 30,31 Sporadic long-term survivors are observed only among patients who underwent complete remission. 29,32 In the past 14 years, we have treated 122 MRCC patients with intralymphatic injection of non-recombinant IL-2, LAK cells, IFN and TF.…”

Section: Discussionmentioning

confidence: 99%

Immunotherapy of metastatic kidney cancer

et al. 2001

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, 122 MRCC patients were treated by monthly intralymphatic injections (containing a mean of 573 IL-2 U and 26 ؋ 10 6 LAK cells) and i.m. administration of IFN and TF; 71 patients also received a 3-day cycle of monthly IL-2 inhalations with a mean of 998 daily U. MRCC cases not treated by immunotherapy (n ‫؍‬ 89) represent our historical controls. Adverse clinical side effects related to treatment were negligible. CR (n ‫؍‬ 11) and PR (n ‫؍‬ 13) were noticed in 24/122 patients. Of 24 responding patients, 17 resumed progression, whereas 7 remain in remission 11-69 months later. The overall median survival of treated patients (28 months) was 3.5-fold higher than the median survival of historical controls (7.5 months), and a Kaplan-Meier curve showed 25% survival 11 years after the beginning of immunotherapy. Apparently, the addition of IL-2 by inhalation improved survival. The present immunotherapy protocol appears to be efficacious, safe, devoid of adverse side effects, far less costly than others and able to offer a good quality of life to MRCC patients; if confirmed in a multicenter trial, it could set the basis for developing lowdose immunomodulatory treatments. © 2001 Wiley-Liss, Inc. Key words: immunotherapy; IL-2; lymphokine-activated killer cells; metastasis; transfer factor; interferon; renal cancerThe most promising systemic therapy for MRCC is immunotherapy with IL-2. 1 The original observations by Rosenberg et al., 2 using i.v. administration of high-dose rIL-2 and LAK in MRCC patients showed encouraging clinical response rates and longlasting remissions. These results have prompted many clinical trials using various administration routes: i.v. both in bolus and continuous or s.c. in combination or not with IFN and/or chemotherapeutic agents. In 1,411 MRCC patients, the overall rate of response was 20%. 3,4 Nonetheless, despite the lowering of the IL-2 dosage and the decrease of the 4% fatal outcome of the initial studies, thanks to the improved selection of patients and the clinical experience acquired, 5,6 the persistence of more often than not severely adverse clinical side effects remains the most important hindrance for the wide use of IL-2.Hence, being aware of the risk from a high IL-2 dose and of its ability to activate, at low doses, tumor mass rejection, 7-9 we attempted to develop alternative protocols. An observation made in 1 MRCC patient, in whom injection of a metastasis with IL-2 and LAK cells was followed by regression not only of the treated tumor but also of several other abdominal lymph node metastases, prompted us to further investigate the low-dose effect using the intralymphatic route. Following intratumor low-dose injections of IL-2 into infiltrating bladder cancers or lymph node metastases of MRCC patients, both the injected and the non-injected distant metastases often disappeared. 7,8 Thus, by administering very low doses of IL-2 and LAK cells into the lymphatic vessels of the foot, we observed encouraging clinical results with minimal side effects. 10,11 To boost the overall ...

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The Natural History of Metastatic Renal Cell Carcinoma: A Computer Analysis

Cited by 495 publications

References 9 publications

Metastatic renal cell carcinoma (RCC): Spontaneous regression, long-term survival and late recurrence

Metastatic renal cell carcinoma (RCC): Spontaneous regression, long-term survival and late recurrence

Incidental and symptomatic renal tumors: impact on patient survival

Immunotherapy of metastatic kidney cancer

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