PURPOSE - Management of metastatic sRCC remains a therapeutic challenge with no standard treatment strategies. Our objective was to evaluate whether metastasectomy has any survival benefit in patients with metastatic sRCC treated with radical nephrectomy(RN).
PATIENTS AND METHODS - From an institutional database of 273 patients with sRCC treated with nephrectomy, we matched 80 patients with synchronous and asynchronous metastasis for age, ECOG performance status, histology and lymph node(LN) status. Matched pairs were then retained only if patients who did not undergo metastasectomy were comparably alive at the time of metastasectomy in matched surgical patients to reduce the bias in survival outcomes. Overall survival(OS) from nephrectomy was studied using univariable and multivariable proportional hazards regression.
RESULTS - Median OS was 8.3 months(95%CI:6.5-10.5 months) and 18.5 months (95%CI:11.5-42.9 months) for patients with synchronous and asynchronous metastases, respectively. OS for patients undergoing metastasectomy for synchronous metastasis compared to non-surgical patients was 8.4 and 8.0 months (p=0.35), respectively. Similarly, OS for patients with asynchronous metastases undergoing metastasectomy compared to non-surgical group was 36.2 and 13.7 months(p=0.29), respectively. On multivariable analysis, positive LN at nephrectomy was associated with increased risk of death in both synchronous and asynchronous patients subgroups; (HR=2.1,95%CI: 1.1, 4.0,p=0.03) and (HR=3.3,95%CI: 1.2, 9.2,p=0.02), respectively.
CONCLUSIONS - In the current study, there was no clear evidence of benefit for patients with sRCC undergoing metastasectomy after nephrectomy. Particularly, the group of patients with pathological LN positive disease at nephrectomy has a considerably worse survival.
The Journal of urology. 2016 Mar 29 [Epub ahead of print]
Arun Z Thomas, Mehrad Adibi, Rebecca S Slack, Leonardo D Borregales, Megan M Merrill, Pheroze Tamboli, Kanishka Sircar, Eric Jonasch, Nizar M Tannir, Surena F Matin, Christopher G Wood, Jose A Karam
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.