Abstract
INTRODUCTION AND OBJECTIVES: Carefully selected renal cell carcinoma (RCC) patients with isolated metastases undergoing metastasectomy can have prolonged survival. The goal of this study was to evaluate the oncologic outcomes in patients undergoing metastasectomy from 5 organ sites. METHODS: RCC patients were identified from 5 individual organ-based databases from a single institution and analyzed. Synchronous patients (distant metastases at nephrectomy or within 6 months (mos) of nephrectomy) were compared to metachronous patients (recurrence greater than 6 mos from nephrectomy). Patients with diffuse metastases at the time of nephrectomy or residual disease after metastasectomy were excluded. RESULTS: There were 138 patients undergoing metastasectomy for RCC in this study with a median follow-up of 2.4 years (range: 0-14.2 years) after metastasectomy. The lung was the most commonsite ofmetastasectomy (n1⁄478, 57%) followedby adrenal (n1⁄427, 20%), liver (n1⁄412, 9%), pancreas (n1⁄415, 11%), and thyroid (n1⁄46, 4%). The 5-year overall survival (OS) after nephrectomy was 88% and the 5 year OS after metastasectomy was 73%. Patients undergoing resection of synchronous metastases (n1⁄432) did not differ from those with metachronous metastases (n1⁄4106) with respect to age, gender, KPS, histology, primary tumors size, metatasectomy site or number of metastases. Median recurrence-free survival was similar after metastasectomy between synchronous and metachronous patients (Hazard ratio for metachronous: 0.76, 95% CI: 0.4-1.2). However, univariate analysis for OS identified initial metachronous presentation (p1⁄40.02), time from initial recurrence diagnosis to metastasectomy >12 mos (p1⁄40.02), and disease free interval (DFI) >6 mos after metastasectomy (p<0.001) to be associated with survival. Those variables not associated with survival included Motzer criteria, primary tumor size, number of metastases resected, metastasectomy site, and systemic therapy. A multivariate analysis confirmed the association of metachronous presentation (p1⁄40.004) and DFI after metastasectomy (p<0.001) with survival. CONCLUSIONS: In this seriesof carefully selectedRCCpatients with synchronous and metachronous presentations of surgically resectable metastatic disease, our results indicate that these patients remain at high risk for systemic recurrence after metastasectomy but can have prolonged survival. Initial metachronous presentation and DFI after metastasectomy are favorable prognostic factors in this patient population.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
