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The effect of metastatic focus on survival after cytoreductive nephrectomy in renal cell carcinoma: Experience of a single center
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Original Article
VOLUME: 52 ISSUE: 2
P: 318-327
2019

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

Acta Haematol Oncol Turc 2019;52(2):318-327
DOI: 10.5505/aot.2019.48403
İsmail Selvi 1
Erdem Öztürk 2
1. Department of Urology, Karabuk University Training and Research Hospital, Karabük, Turkey
2. Department of Urology, Health Sciences University Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
3.
No information available.
No information available
Received Date: 2019-07-01T21:31:01
Accepted Date: 2019-08-30T10:07:54
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Abstract

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.