PURPOSE: Metastatic renal cell carcinoma (RCC) can be clinically diverse in terms of the pattern of metastatic disease and response to treatment.
We studied the impact of metastasis and location on cancer-specific survival (CSS).
PATIENTS AND METHODS: The records of 2017 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1971 to 2012 at 22 centers in the United States and Europe were analyzed. Number and location of synchronous metastases were compared with respect to patients' CSS. Multivariable Cox regression models were used to quantify the impact of covariates.
RESULTS: Lymph node (n=155) or distant metastasis (n=725) were present in 880 (44%) of the patients. In patients with distant disease, 385 (53%) had an isolated metastasis. 5-year-CSS was 51.3% (CI 48.6%-53.9%) in the entire group. In univariable analysis, patients with isolated lymph node metastasis had a significantly worse CSS compared with patients with a solitary distant metastasis. The location of distant metastasis did not have any significant effect on CSS. In multivariable analysis, the presence of lymph node metastasis, isolated distant metastasis, and multiple distant metastases were independently associated with CSS. Moreover, higher tumor thrombus level, papillary histology, and the use of postoperative systemic therapy were independently associated with worse CSS.
CONCLUSIONS: In our multi-institutional series of patients with RCC who underwent radical nephrectomy and tumor thrombectomy, almost half of the patients had synchronous lymph node or distant organ metastasis. Survival was superior in patients with solitary distant metastasis compared with isolated lymph node disease.
Written by:
Tilki D, Hu B, Nguyen HG, Dall'Era MA, Bertini R, Carballido JA, Chandrasekar T, Chromecki T, Ciancio G, Daneshmand S, Gontero P, Gonzalez J, Haferkamp A, Hohenfellner M, Huang WC, Koppie TM, Linares E, Lorentz CA, Mandel P, Martinez-Salamanca J, Master VA, Matloob R, McKiernan JM, Mlynarczyk CM, Montorsi F, Novara G, Pahernik S, Palou J, Pruthi RS, Ramaswamy K, Faba OR, Russo P, Shariat SF, Spahn M, Terrone C, Thieu W, Vergho D, Wallen EM, Xylinas E, Zigeuner R, Libertino JA, Evans CP. Are you the author?
Institution(s): See publishing journal.
Reference: J Urol. 2014 Jul 22. pii: S0022-5347(14)04036-1.
doi: 10.1016/j.juro.2014.07.087
PubMed Abstract
PMID: 25063493