Prognosis of Renal Cell Carcinoma with Bone Metastases: Experience from a Large Cancer Centre - Beyond the Abstract

This study aimed to investigate the prognostic role of bone metastases (BMs) in a large cohort of patients with metastatic renal cell carcinoma (mRCC) treated at Gustave Roussy Cancer Campus (GRCC) from 1992 to 2016. From 1750 patients with a diagnosis of RCC followed at GRCC, 300 (17%) patients with BMs were identified. Median OS after diagnosis of BMs was 23.2 months, consistent with previously reported data.1,2 We showed that clear-histology and MSKCC risk group were significantly associated with worse prognosis.  Besides, risk group according to MSKCC was confirmed to be a predictor of OS at the multivariate analysis.

Regarding different sites of BMs, patients with metastases localized to long bones were characterized by a better prognosis. On the other hand, no significant difference was found between synchronous and metachronous BMs. Moreover, surprisingly compared with other series,3,4 presence of concomitant liver metastases was not an independent prognostic factor. However, the most interesting result concerns the patients presenting with a solitary lesion at the initial diagnosis of RCC (SSBM). In our study, we found that they were characterized by a better prognosis.  Improved survival in this group of patients may have different explanations but the opportunity to perform a radical resection seems to have the greatest impact. Indeed, the large majority of patients with a SSBM underwent bone surgery (76%). Moreover, regarding BMs’ therapy, radical resection was correlated with longer survival, while palliative surgery, radiotherapy and the other local and systemic treatments were not significantly associated with OS.

This data is even more interesting if we consider that studies on management of solitary BMs are limited and there are no standard recommendations on the best treatment modality to use in this group of patients.  Based on these findings, radical surgery needs to be performed in patients with single BM to achieve local tumor control, to delay the systemic treatments and to improve survival. 


Written by: Fiorella Ruatta, MD, Division of Medical Oncology, Institute for Cancer Research and Treatment, Torino, Italy, and Lisa Derosa, MD, Ph.D., Department of Cancer Medicine, Gustave Roussy Cancer Campus, Paris-Sud University, Villejuif, France.

References:
1. Kalra S, Verma J, Atkinson BJ, et al. Outcomes of Patients With Metastatic Renal Cell Carcinoma and Bone Metastases in the Targeted Therapy Era. Clin Genitourin Cancer. 2017;18(17):30010-30011.
2. Santini D, Procopio G, Porta C, et al. Natural history of malignant bone disease in renal cancer: final results of an Italian bone metastasis survey. PLoS One. 2013;8(12):e83026.
3. Santoni M, Santini D, Massari F, et al. Heterogeneous drug target expression as possible basis for different clinical and radiological response to the treatment of primary and metastatic renal cell carcinoma: suggestions from bench to bedside. Cancer Metastasis Rev. 2014;33(1):321-331.
4. Grassi P, Verzoni E, Porcu L, et al. Targeted therapies in advanced renal cell carcinoma: the role of metastatic sites as a prognostic factor. Future Oncol. 2014;10(8):1361-1372.

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