Abstract
This study evaluated the effects of metastasectomy on overall survival (OS) and progression-free survival (PFS) in metastatic renal cell carcinoma (mRCC) according to metastatic organs. The medical records (2005–2017) of 273 patients with mRCC were analyzed retrospectively to evaluate OS and PFS according to metastatic organs and their metastasectomy states. The Cox proportional hazard model was used to determine the prognostic significance of metastasectomy. The Kaplan-Meier curve and log-rank test were used to compare groups with different modalities and metastatic organs at a statistical significance of p < 0.05. The overall median age was 57 years; 175 (64.3%) and 83 (30.4%) patients received cytoreductive nephrectomy and metastasectomy, respectively. The metastasectomy group was significantly younger and had a lower clinical T stage with significantly better PFS/OS (20.2/32.0 vs. 9.7/12.8 months) than that in the non-metastasectomy group (N = 190, p < 0.05). Liver with lung metastases were the worst metastatic combination for survivals in which liver metastasis was the only significant unfavorable risk factor for both PFS (HR 1.67) and OS (HR 1.74) (p < 0.05). Multivariable analysis confirmed that metastasectomy was a significant favorable risk factor for PFS (HR 0.70) and OS (HR 0.56) (p < 0.05) along with non-clear cell type (HR 0.61 for PFS), whereas the nuclear grade and poor Heng risk group were unfavorable risk factors (HR > 2.0) for both PFS and OS (p < 0.05). Metastasectomy and the affected metastatic organs significantly influenced prognostic survival in mRCC.
Highlights
Metastasis is present in about 25–35% of cases of newly diagnosed renal cell carcinoma (RCC); metastasis occurs in about 20–40% of localized primary RCC following surgical resection
This study aimed to compare the effects of metastasectomy to those of non-metastasectomy regarding overall survival (OS) and progression-free survival (PFS) in synchronous metastatic renal cell carcinoma (mRCC) according to metastatic organs and multiple clinicopathological parameters; this study aimed to determine the prognostic risk factors for patients who underwent either metastasectomy or nonmetastasectomy for mRCC
Liver metastasis in this study showed a poor prognosticator of survival, with a median OS of 7.4 months and a similar diagnostic prevalence of liver metastasis in mRCC (18.8%) as that previously reported (20%) [26]
Summary
Metastasis is present in about 25–35% of cases of newly diagnosed renal cell carcinoma (RCC); metastasis occurs in about 20–40% of localized primary RCC following surgical resection. In the current targeted therapy era, the benefit of surgical resection of mRCC has not been clearly identified; targeted agents have resulted in a modest tumor reduction of 20–30%, with improved progression-free survival (PFS) and OS of about 7–9 months compared to that of the past cytokine era [5, 6]. A recent CARMENA (NCT00930033) trial demonstrated a decreasing role of cytoreductive nephrectomy for mRCC compared to that of sunitinib alone [7]. The advent of multiple targeted and combination therapies for mRCC has created question regarding the role of surgery for both primary RCC and metastatic tumors in terms of prognostic survival
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