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Multicenter Study
. 2015 Feb 5;34(1):10.
doi: 10.1186/s13046-015-0122-0.

Bone metastases in patients with metastatic renal cell carcinoma: are they always associated with poor prognosis?

Matteo Santoni  1 , Alessandro Conti  2 , Giuseppe Procopio  3 , Camillo Porta  4 , Toni Ibrahim  5 , Sandro Barni  6 , Francesco Maria Guida  7 , Andrea Fontana  8 , Alfredo Berruti  9 , Rossana Berardi  10 , Francesco Massari  11 , Bruno Vincenzi  12 , Cinzia Ortega  13 , Davide Ottaviani  14 , Giacomo Carteni  15 , Gaetano Lanzetta  16   17 , Delia De Lisi  18 , Nicola Silvestris  19 , Maria Antonietta Satolli  20 , Elena Collovà  21 , Antonio Russo  22 , Giuseppe Badalamenti  23 , Stefano Luzi Fedeli  24 , Francesca Maria Tanca  25 , Vincenzo Adamo  26 , Evaristo Maiello  27 , Roberto Sabbatini  28 , Alessandra Felici  29 , Saverio Cinieri  30 , Rodolfo Montironi  31 , Sergio Bracarda  32 , Giuseppe Tonini  33 , Stefano Cascinu  34 , Daniele Santini  35
Affiliations
Multicenter Study

Bone metastases in patients with metastatic renal cell carcinoma: are they always associated with poor prognosis?

Matteo Santoni et al. J Exp Clin Cancer Res. .

Abstract

Purpose: Aim of this study was to investigate for the presence of existing prognostic factors in patients with bone metastases (BMs) from RCC since bone represents an unfavorable site of metastasis for renal cell carcinoma (mRCC).

Materials and methods: Data of patients with BMs from RCC were retrospectively collected. Age, sex, ECOG-Performance Status (PS), MSKCC group, tumor histology, presence of concomitant metastases to other sites, time from nephrectomy to bone metastases (TTBM, classified into three groups: <1 year, between 1 and 5 years and >5 years) and time from BMs to skeletal-related event (SRE) were included in the Cox analysis to investigate their prognostic relevance.

Results: 470 patients were enrolled in this analysis. In 19 patients (4%),bone was the only metastatic site; 277 patients had concomitant metastases in other sites. Median time to BMs was 16 months (range 0 - 44y) with Median OS of 17 months. Number of metastatic sites (including bone, p = 0.01), concomitant metastases, high Fuhrman grade (p < 0.001) and non-clear cell histology (p = 0.013) were significantly associated with poor prognosis. Patients with TTBM >5 years had longer OS (22 months) compared to patients with TTBM <1 year (13 months) or between 1 and 5 years (19 months) from nephrectomy (p < 0.001), no difference was found between these two last groups (p = 0.18). At multivariate analysis, ECOG-PS, MSKCC group and concomitant lung or lymph node metastases were independent predictors of OS in patients with BMs.

Conclusions: Our study suggest that age, ECOG-PS, histology, MSKCC score, TTBM and the presence of concomitant metastases should be considered in order to optimize the management of RCC patients with BMs.

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Figures

Figure 1
Figure 1
Bone metastases occurred at time of clear cell RCC diagnosis (A) and 12 years after radical nephrectomy (B).
Figure 2
Figure 2
Overall Survival (OS) from the diagnosis of bone metastases (BMs) based on age (2A) and histology (2B).
Figure 3
Figure 3
Distribution of sites of concomitant distant metastases in patients with bone metastases (BMs).
Figure 4
Figure 4
Overall survival (OS) from the diagnosis of bone metastases (BMs) based on the time of bone recurrence from nephrectomy (TTBM).
Figure 5
Figure 5
Risk Stratification Model in patients with bone metastases (BMs) based on the presence of significant prognostic factors resulted from multivariate analysis (MSKCC risk, ECOG-PS, lymph-node and/or lung metastases).
See this image and copyright information in PMC

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