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. 2015 Feb;193(2):436-42.
doi: 10.1016/j.juro.2014.07.087. Epub 2014 Jul 22.

Impact of synchronous metastasis distribution on cancer specific survival in renal cell carcinoma after radical nephrectomy with tumor thrombectomy

Derya Tilki  1 , Brian Hu  2 , Hao G Nguyen  3 , Marc A Dall'Era  3 , Roberto Bertini  4 , Joaquín A Carballido  5 , Thenappan Chandrasekar  3 , Thomas Chromecki  6 , Gaetano Ciancio  7 , Siamak Daneshmand  8 , Paolo Gontero  9 , Javier Gonzalez  10 , Axel Haferkamp  11 , Markus Hohenfellner  12 , William C Huang  13 , Theresa M Koppie  14 , Estefania Linares  5 , C Adam Lorentz  15 , Philipp Mandel  16 , Juan I Martinez-Salamanca  5 , Viraj A Master  15 , Rayan Matloob  4 , James M McKiernan  17 , Carrie M Mlynarczyk  17 , Francesco Montorsi  4 , Giacomo Novara  18 , Sascha Pahernik  12 , Juan Palou  19 , Raj S Pruthi  20 , Krishna Ramaswamy  13 , Oscar Rodriguez Faba  19 , Paul Russo  21 , Shahrokh F Shariat  22 , Martin Spahn  23 , Carlo Terrone  24 , William Thieu  3 , Daniel Vergho  23 , Eric M Wallen  20 , Evanguelos Xylinas  25 , Richard Zigeuner  6 , John A Libertino  26 , Christopher P Evans  3
Affiliations

Impact of synchronous metastasis distribution on cancer specific survival in renal cell carcinoma after radical nephrectomy with tumor thrombectomy

Derya Tilki et al. J Urol. 2015 Feb.

Abstract

Purpose: Metastatic renal cell carcinoma can be clinically diverse in terms of the pattern of metastatic disease and response to treatment. We studied the impact of metastasis and location on cancer specific survival.

Materials and methods: The records of 2,017 patients with renal cell cancer and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1971 to 2012 at 22 centers in the United States and Europe were analyzed. Number and location of synchronous metastases were compared with respect to patient cancer specific survival. Multivariable Cox regression models were used to quantify the impact of covariates.

Results: Lymph node metastasis (155) or distant metastasis (725) was present in 880 (44%) patients. Of the patients with distant disease 385 (53%) had an isolated metastasis. The 5-year cancer specific survival was 51.3% (95% CI 48.6-53.9) for the entire group. On univariable analysis patients with isolated lymph node metastasis had a significantly worse cancer specific survival than those with a solitary distant metastasis. The location of distant metastasis did not have any significant effect on cancer specific survival. On multivariable analysis the presence of lymph node metastasis, isolated distant metastasis and multiple distant metastases were independently associated with cancer specific survival. Moreover higher tumor thrombus level, papillary histology and the use of postoperative systemic therapy were independently associated with worse cancer specific survival.

Conclusions: In our multi-institutional series of patients with renal cell cancer who underwent radical nephrectomy and tumor thrombectomy, almost half of the patients had synchronous lymph node or distant organ metastasis. Survival was superior in patients with solitary distant metastasis compared to isolated lymph node disease.

Keywords: carcinoma; inferior; neoplasm metastasis; prognosis; renal cell; survival; vena cava.

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