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. 2010 Aug;1(4):149-157.
doi: 10.4021/wjon232w. Epub 2010 Aug 29.

Unusual Metastases in Renal Cell Carcinoma: A Single Institution Experience and Review of Literature

Cynthia Villarreal-Garza  1 , Sandra I Perez-Alvarez  1 , Ivan R Gonzalez-Espinoza  1 , Eucario Leon-Rodriguez  1
Affiliations

Unusual Metastases in Renal Cell Carcinoma: A Single Institution Experience and Review of Literature

Cynthia Villarreal-Garza et al. World J Oncol. 2010 Aug.

Abstract

Background: To report location and management of atypical metastases from renal cell carcinoma (RCC) in the Instituto Nacional de Ciencias Medicas e Investigacion Salvador Zubiran (INCMNSZ) in Mexico City.

Methods: Between 1987 to 2009, 545 patients with RCC were retrospectively identified at the INCMNSZ. Patients with unusual metastases confirmed by histopathology were analyzed. Epidemiological, clinical, diagnosis, treatment and outcome data were reviewed.

Results: Sixty patients developed 98 unusual metastases secondary to RCC. The group was comprised of 35 men (58.3%), with a median age of 60 years at diagnosis. Metachronous unusual metastases with primary renal cancer were observed in 37 individuals (61.7%). Median time from primary RCC diagnosis to the first unusual metastasis was 16.5 months. Median survival from diagnosis of the first unusual metastasis to death was 5.0 months (CI 95%: 2.8-7.2 months). Patients with an initial solitary metastatic lesion in an unusual site (28.3%) had a better survival compared to patients who primarily presented with multiple metastases, 17.0 (CI 95%: 6.1-27.9) Vs 3.0 months (CI 95%: 0.9-5.1), p = 0.001. Unusual metastasis resection (21 patients) improved survival, 25.0 (CI 95%: 5.1-44.9) Vs 3.0 months (CI 95%: 0.8-5.2), p < 0.0001. No survival difference was observed between localization of unsual metastases (p = 0.72).

Conclusions: In patients with advanced RCC we suggest an individual diagnostic and surgical approach to achieve complete resection with disease-free margins, even in the presence of unusual metastatic sites, multifocality, or history of metastasectomy. These strategy might provide not only palliation for symptoms, but an opportunity for meaningful disease free and overall survival.

Keywords: Atypical metastases; Metastatic renal cancer; Renal cancer; Renal cell carcinoma; Single institution experience; Unusual metastases.

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Figures

Figure 1
Figure 1
Overall survival from diagnosis of the first unusual metastasis to death or last follow-up (n = 60).
Figure 2
Figure 2
Survival from diagnosis of patients with an initial solitary unusual metastatic lesion to death or last follow-up (n = 17) compared to patients who primarily presented with multiple metastases (typical or atypical localizations) (n = 43).
Figure 3
Figure 3
Survival from diagnosis of the first unusual metastasis to death or last follow-up compared between resectable (n = 21) vs no-resectable (n = 39) metastasis.
Figure 4
Figure 4
Survival from diagnosis of the first unusual metastasis to death or last follow-up compared between systems.
See this image and copyright information in PMC

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