Diagnosis and treatment of renal cell carcinoma with bone metastasis as the first symptom

Abstract

Objective To improve the understanding of renal cell carcinoma (RCC) by analyzing bone-related symptoms as the first manifestation in metastatic RCC. Methods Combined with literature review, the clinical data of 33 patients diagnosed with renal cell carcinoma with bone-related symptom as the primary manifestation were analyzed retrospectively, including symptoms, physical signs, imaging and laboratory findings, pathological examination. Results Of all 33 bone-metastases RCC patients, 29 of them were found with ostealgia, 4 of them with pathological fracture and 1 patient presented urology symptom. The level of alkaline phosphatase (ALP) rose in 6 cases (>130U/L) and serum calcium reduced in 11 cases. With further examination, bone metastasis was found in all 33 patients and most common metastatic spots include spine, pelvis, rib and hip joint. One and more than one other organ metastases were found in 7 victims. All bone metastatic lesions were confirmed by pathological diagnosis with clear cell renal cell carcinoma being the most common renal cancer subtype. Conclusions RCC is prone to develop distant metastasis. Some patients with RCC have distant metastasis as the first manifestation. RCC with bone-metastasis may present unexplainable symptom like bone ache, pathological fracture, and the diagnosis can be confirmed by pathological feature analysis and immunostaining. Key words: Renal cell carcinoma (RCC); Bone metastases; First manifestation; Skeletal related event (SRE)