Abstract
Simple SummaryThis multicentric paper aimed at evaluating the role of pulmonary metastasectomy in patients affected by metastatic renal cell carcinoma. The impact of pulmonary metastasectomy was analysed with respect to long-term survival and disease-free survival in a wide population of patients affected by pulmonary metastases from renal cell carcinoma. The prognostic value of factors affecting survival, disease-free interval and disease-free survival was evaluated. Our results aid clinicians in identifying those patients affected by pulmonary metastases from renal cell carcinoma who are more likely to benefit from pulmonary metastasectomy.In this paper we aimed to address the role of pulmonary metastasectomy (PM) in patients affected by Lung Metastases (LM) from Renal Cell Carcinoma (RCC) and to analyse prognostic factors affecting overall survival (OS), disease-free interval (DFI) between primary RCC and first LM, and disease-free survival (DFS) after PM and before lung recurrence. Medical records of 210 patients who underwent PM from RCC in 4 Italian Thoracic Centres, from January 2000 to September 2019, were collected and analysed. All patients underwent RCC resection before lung surgery. The main RCC histology was clear cells (188, 89.5%). The 5- and 10-year OS from the first lung operation were 60% and 34%, respectively. LM synchronous with RCC (p = 0.01) and (Karnofsky Performance Status Scale) KPSS < 80% (p < 0.001) negatively influenced OS. Five- and 10-year DFI were 54% and 28%, respectively. The main factors negatively influencing DFI were: male gender (p = 0.039), KPSS < 80% (p = 0.009) and lactate dehydrogenase > 1.5 times 140 U/L (p = 0.001). Five- and 10-year disease-free survival were 54% and 28%, respectively; multiple LM (p = 0.036), KPSS < 80% (p = 0.001) and histology of RCC other than clear cells negatively influenced disease-free survival. Conclusions: patients with KPSS > 80%, single metachronous LM with a long DFI from RCC diagnosis, and clear cell histology, benefit from pulmonary metastasectomy.
Highlights
Renal cell carcinoma (RCC) is the seventh most frequently diagnosed cancer worldwide, accounting for about 3% of all cancers in adults
Prognostic factors negatively influencing overall survival (OS) at univariate analysis were: presence of multiple (≥2) lung metastases (5-year survival 45% vs. 69%, p = 0.041, Figure 1A), dimensions of lung metastases ≥3 cm (5-year survival 44% vs. 65%, p = 0.043, Figure 1B), lung metastases synchronous with primary renal cancer (5-year survival 40% vs. 62%, p = 0.032, Figure 1C), KPSS < 80% (5-year survival 0% vs. 63%, p < 0.001, Figure 1D); adjuvant therapies after lung metastasectomy had only a trend towards significance (p = 0.069)
Comparing the outcome of patients affected by single vs. multiple Lung Metastases (LM), we found a statistically significant better OS in patients surgically treated for a single LM (5-year survival of 69%) when matched with multiple LM patients (5-year survival of 45%)
Summary
Renal cell carcinoma (RCC) is the seventh most frequently diagnosed cancer worldwide, accounting for about 3% of all cancers in adults. It represents the third most common urinary tract malignancy [1], with more than 140,000 deaths in 2013 [2]. About 30% of patients affected by RCC show distant metastases at the time of diagnosis, while another. 25% develop metachronous metastases [3]. The lack of an effective therapy for advanced disease leads to RCC being the sixth leading cause of death for cancer worldwide [4].
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