Acta Oncol Tur.. 2019; 52(2): 318-327 | DOI: 10.5505/aot.2019.48403

The effect of metastatic focus on survival after cytoreductive nephrectomy in renal cell carcinoma: Experience of a single center

Ýsmail Selvi¹, Erdem Öztürk^2
1Department of Urology, Karabuk University Training and Research Hospital, Karabük, Turkey
²Department of Urology, Health Sciences University Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey

INTRODUCTION: Despite the newly developed targeted therapies in metastatic renal cell carcinoma (RCC), survival rates are still low.The most common metastatic areas are lung, liver and bone. Among these, especially cases with bone metastasis are associated with worse prognosis. In this study, we aimed to determine the effect of metastatic focus on oncologic outcomes in RCC and to evaluate other prognostic factors affecting overall survival.
METHODS: Between January 2009 and December 2016, 35 patients with metastatic RCC who underwent cytoreductive nephrectomy were evaluated retrospectively.Demographic, pathological, clinical data, progression status and survival outcomes after nephrectomy were recorded and the patients were divided into two groups: those with bone metastases (Group I) and those with only visceral organ metastasis (Group II).
RESULTS: The mean age of the patients was 59.20±11.72 years.During the median follow-up period of 11 (2-90) months, 25 patients (71.4%) had progression and 27 patients (77.1%) died.IMDC risk score (p=0.008),MSKCC risk score (p=0.025), progression rate (85.0% vs 53.3%, p=0.04) and mortality rate (90.0% vs 60.0%), p = 0.036) were found to be significantly higher in Group I. The predicted overall survival was significantly lower in Group I (18.60 vs. 43.60 months, p=0.036).In multivariate analysis, IMDC score was found to be independent predictor for progression-free survival. On the other hand, Fuhrman grade, bone involvement and IMDC score were independent predictors for overall survival.
DISCUSSION AND CONCLUSION: It is seen that overall survival decreases especially in the presence of accompanying visceral organ metastasis, multiple or axial bone involvement in RCC with bone metastases.Closer follow-up is required for cases with bone metastasis because these patients have worse prognosis than those with visceral organ involvement except for brain.In addition, the rates of bone-related events are higher in these patients and cause decrease in quality of life.Therefore, different local palliative treatments for bone should be chosen more carefully.

Keywords: Bone metastasis, cytoreductive nephrectomy, oncologic outcomes, progression, renal cell carcinoma, visceral metastasis

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Renal hücreli karsinomda metastaz odaðýnýn sitoredüktif nefrektomi sonrasý saðkalýma etkisi: Tek merkez deneyimi

Ýsmail Selvi¹, Erdem Öztürk^2
1Karabük Üniversitesi Eðitim ve Araþtýrma Hastanesi, Üroloji Kliniði, Karabük
²Saðlýk Bilimleri Üniversitesi Dr. Abdurrahman Yurtaslan Ankara Onkoloji Eðitim ve Araþtýrma Hastanesi, Üroloji Kliniði, Ankara

GÝRÝÞ ve AMAÇ: Metastatik renal hücreli karsinomda (RHK) yeni geliþtirilen hedefe yönelik tedavilere raðmen halen saðkalým oranlarý düþüktür. En sýk metastaz gözlenen alanlar arasýnda yer alan akciðer, karaciðer ve kemik tutulumu içerisinde, özellikle de kemik metastazý saptanan olgular daha kötü prognoz ile iliþkilendirilmektedir. Çalýþmamýzda RHK’da metastaz odaðýnýn onkolojik sonuçlara etkisini belirlemeyi ve genel saðkalýma etki eden diðer prognostik faktörleri de deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2009-Aralýk 2016 tarihleri arasýnda, taný anýnda metastaz saptanan ve sitoredüktif nefrektomi yapýlan RHK olgularýndan, verilerine tam olarak ulaþýlabilen 35 hasta retrospektif olarak deðerlendirildi. Hastalarýn demografik, patolojik, klinik verileri, nefrektomi sonrasý progresyon durumlarý ve saðkalým verileri kaydedilerek, hastalar kemik metastazý bulunanlar (Grup I) ve sadece visseral organ metastazý olanlar (Grup II) þeklinde iki gruba ayrýldý.
BULGULAR: Hastalarýn ortalama yaþý 59.20 ± 11.72 olup, ortanca 11 (2-90) aylýk takip süresi boyunca 25 (% 71.4) hastada progresyon, 27 (%77.1) hastada ölüm gerçekleþmiþtir. Grup I' de IMDC (p=0.008) ve MSKCC risk skorlarý (p=0.025) Grup II' ye göre daha yüksek bulunurken, yine Grup I' de progresyon (%85.0 vs. %53.3, p=0.04) ve ölüm (%90.0 vs. %60.0, p=0.036) oranlarý anlamlý olarak daha yüksek gözlendi. Öngörülen genel saðkalým süresi, Grup I'de anlamlý olarak daha düþük bulundu (18.60 vs. 43.60 ay, p=0.036). Çok deðiþkenli analizde, IMDC skoru progresyonsuz sað kalýmý öngörmede; Fuhrman derecesi, metastaz odaðýnýn kemik olmasý ve IMDC skoru ise genel saðkalýmý öngörmede baðýmsýz prediktif faktörler olarak bulundu.
TARTIÞMA ve SONUÇ: Kemik metastazlý RHK olgularýnda özellikle de eþlik eden visseral organ metastazý, multipl kemik tutulumu, aksiyel kemik tutulumlarýnda genel saðkalýmýn azaldýðý görülmektedir. Bu hastalarda, beyin dýþýndaki diðer visseral organ tutulumu olan olgulara göre daha kötü prognoz gözlendiðinden, daha yakýn takip gerekmektedir. Ayrýca hayat kalitesini düþüren kemikle iliþkili olay gözlenme oranlarý da daha yüksek olduðundan, uygulanabilecek kemiðe yönelik farklý lokal palyatif tedaviler konusunda daha dikkatli davranýlmalýdýr.

Anahtar Kelimeler: Kemik metastazý, onkolojik sonuçlar, progresyon, renal hücreli karsinom, sitoredüktif nefrektomi, visseral metastaz

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