Bone metastases from renal cell carcinoma: patient survival after surgical treatment

Andreas Fottner, Melinda Szalantzy, Lilly Wirthmann, Michael Stähler, Andrea Baur-Melnyk, Volkmar Jansson, Hans Roland Dürr, Andreas Fottner, Melinda Szalantzy, Lilly Wirthmann, Michael Stähler, Andrea Baur-Melnyk, Volkmar Jansson, Hans Roland Dürr

Abstract

Background: Surgery is the primary treatment of skeletal metastases from renal cell carcinoma, because radiation and chemotherapy frequently are not effecting the survival. We therefore explored factors potentially affecting the survival of patients after surgical treatment.

Methods: We retrospectively reviewed 101 patients operatively treated for skeletal metastases of renal cell carcinoma between 1980 and 2005. Overall survival was calculated using the Kaplan-Meier method. The effects of different variables were evaluated using a log-rank test.

Results: 27 patients had a solitary bone metastasis, 20 patients multiple bone metastases and 54 patients had concomitant visceral metastases. The overall survival was 58% at 1 year, 37% at 2 years and 12% at 5 years. Patients with solitary bone metastases had a better survival (p < 0.001) compared to patients with multiple metastases. Age younger than 65 years (p = 0.036), absence of pathologic fractures (p < 0.001) and tumor-free resection margins (p = 0.028) predicted higher survival. Gender, location of metastases, time between diagnosis of renal cell carcinoma and treatment of metastatic disease, incidence of local recurrence, radiation and chemotherapy did not influence survival.

Conclusions: The data suggest that patients with a solitary metastasis or a limited number of resectable metastases are candidates for wide resections. As radiation and chemotherapy are ineffective in most patients, surgery is a better option to achieve local tumor control and increase the survival.

Figures

Figure 1
Figure 1
A Kaplan-Meier survival curve of patients based on the metastatic pattern shows that patients with solitary bone metastases had a better survival (p < 0.001) than patients with multiple bone metastases or additional visceral metastases.
Figure 2
Figure 2
A Kaplan-Meier survival curve of patients based on the surgical margin according to the Enneking classification [16]shows that patients with a tumor-free resection margin have a better survival rat (p = 0.028) than patients with a tumor-infiltrated resection margin.
Figure 3
Figure 3
A Kaplan-Meier survival curve of patients stratified on the basis of being diagnosed as "free of disease" or not shows that patients with the diagnosis "free of disease" at any time after the operation had a better survival (p < 0.001).
Figure 4
Figure 4
A Kaplan-Meier survival curve of patients based on whether a pathologic fracture was present before the operation or not shows that presence of a pathologic fracture decreases the prognosis of the patient (p < 0.001).

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Source: PubMed

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