ORLANDO, FL USA (UroToday.com) - The authors describe that patients with recurrent renal cell carcinoma (rRCC) may experience lengthy disease free survival (DFS) following surgical removal of all metastases (complete metastasectomy – CM). They sought to characterize any prognostic factors that might be associated with DFS using this single-institution series of patients.
This study examined patients who received both nephrectomy for localized RCC and subsequent CM between 1990-2013; these records were then subjected to Kaplan-Meier analysis for DFS (determined by biopsy recurrence or radiographic progression), cancer-specific, and overall survival. Variables were examined for association with DFS on bivariate analysis—by log-rank test and univariate Cox regression, and a multivariate Cox regression model highlighted whether variables were associated with prognosis.
The study identified 61 patients with complete metastasectomy, all involving one organ per patient. The median time to recurrence was 25 months and median follow-up after CM was 44 months. Median DFS was almost 2 years, while cancer-specific and overall survival was 6 years or greater. On multivariate analysis, DFS was only associated with Karnofsky performance status (a measure of general well-being) and the number of metastases; it was not associated with any other pathologic or clinical variables. In a subgroup analysis, the authors found that patients with KPS > 80 and ≤2 metastases had significantly higher median DFS compared to those with KPS ≤ 80 or >2 metastases (34 months vs 7 months, respectively). However, this was not associated with improved OS.
These findings suggest that appropriate patient selection for metastasectomy may lead to prolonged survival following successful surgery, however, whether this intervention may have a significant effect on overall survival is unclear. Further analyses should seek to replicate this study in a larger cohort with longer follow up in order to establish whether these characteristics might also impact overall survival.
Presented by Ryan Kopp, MD at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
Memorial Sloan Kettering Cancer Center, New York, NY USA
Written by Eric Ballon-Landa, BA, University of California (Irvine), and medical writer for UroToday.com