Surgical treatment of osseous metastases in patients with renal cell carcinoma

Abstract

Forty-five patients who underwent surgical treatment for osseous metastases secondary to renal cell carcinoma between 1980 and 1998 were reviewed. The diagnosis was confirmed histologically in all patients. The mean age of the 34 men was 61.5 +/- 9 years and of the 11 women 55.2 +/- 17.6 years. The most common locations of the metastases were the spine (15 patients), the pelvis (eight patients), and the femur (11 patients). In 21 patients, the renal cell carcinoma was diagnosed when the osseous metastasis was detected. The time from diagnosis of the primary tumor to metastasis in the remaining patients ranged from 0 to 23 years (mean, 3 +/- 5 years). At presentation, 19 patients had a singular lesion. Nine patients had multiple osseous metastases and 17 patients had additional visceral involvement. In seven patients, a wide or radical resection was done; in 35 patients, a palliative procedure was done; and in three patients, only a diagnostic procedure was done. For the whole group, the survival was 49% after 1 year, 39% after 2 years, and 15% after 5 years. Only the extent of the disease and the latency period between primary tumor diagnosis and first detection of osseous metastasis could be identified as independent factors of survival. Nine patients with solitary metastasis to the bone more than 12 months after resection of the primary tumor showed a 5-year survival of 54%.