Abstract
PurposeAim of this study was to investigate for the presence of existing prognostic factors in patients with bone metastases (BMs) from RCC since bone represents an unfavorable site of metastasis for renal cell carcinoma (mRCC).Materials and methodsData of patients with BMs from RCC were retrospectively collected. Age, sex, ECOG-Performance Status (PS), MSKCC group, tumor histology, presence of concomitant metastases to other sites, time from nephrectomy to bone metastases (TTBM, classified into three groups: <1 year, between 1 and 5 years and >5 years) and time from BMs to skeletal-related event (SRE) were included in the Cox analysis to investigate their prognostic relevance.Results470 patients were enrolled in this analysis. In 19 patients (4%),bone was the only metastatic site; 277 patients had concomitant metastases in other sites. Median time to BMs was 16 months (range 0 − 44y) with Median OS of 17 months. Number of metastatic sites (including bone, p = 0.01), concomitant metastases, high Fuhrman grade (p < 0.001) and non-clear cell histology (p = 0.013) were significantly associated with poor prognosis. Patients with TTBM >5 years had longer OS (22 months) compared to patients with TTBM <1 year (13 months) or between 1 and 5 years (19 months) from nephrectomy (p < 0.001), no difference was found between these two last groups (p = 0.18). At multivariate analysis, ECOG-PS, MSKCC group and concomitant lung or lymph node metastases were independent predictors of OS in patients with BMs.ConclusionsOur study suggest that age, ECOG-PS, histology, MSKCC score, TTBM and the presence of concomitant metastases should be considered in order to optimize the management of RCC patients with BMs.
Highlights
Renal cell carcinoma (RCC) accounts for approximately 5% of epithelial cancers worldwide with clear cell RCC representing 85% of these tumors [1]
We retrospectively collected clinical data of 511 patients with RCC Bone metastases (BMs) from 19 Italian Institutions followed between January 2001 and April 2014
Of 470 patients were available for this analysis (41 were excluded due to lack of data on BMs or follow-up)
Summary
Renal cell carcinoma (RCC) accounts for approximately 5% of epithelial cancers worldwide with clear cell RCC representing 85% of these tumors [1]. Almost one third of patients present with synchronous metastatic disease and another 20% experience recurrence or develop metastatic RCC (mRCC) after nephrectomy [2,3]. New clinical and molecular predictive and prognostic biomarkers are dramatically required in order to optimize the use of novel effective agents for mRCC. Bone metastases (BMs) occurs in almost 35% of patients with advanced RCC [4]. The management of patients with BMs has been markedly improved by the introduction of bone-directed targeted therapies, their prognosis is still dismal, with a mean survival of 12 months [4,5,6]. Almost 70% of RCC patients with BMs experience at least one SRE [7]
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