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Laru L, Ronkainen H, Ohtonen P, Vaarala MH. The impact of metastasectomy on survival of patients with synchronous metastatic renal cell cancer in Finland: A nationwide study. Scand J Surg 2024; 113:219-228. [PMID: 38433655 DOI: 10.1177/14574969241234485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND OBJECTIVE Most of the studies on metastasectomy in renal cell cancer are based on metachronous, often oligometastatic disease. Prior data on the impact of metastasectomy in synchronous metastatic renal cell cancer (mRCC) is, however, very scarce. We aimed to investigate the role of complete and incomplete metastasectomy in a large, nationwide patient population. METHODS We analyzed nationwide data, including all synchronous mRCC cases in Finland diagnosed during a 6-year period identified from the Finnish Cancer Registry, and complemented with patient records from the treating hospitals. We only included the patients who underwent removal of the primary tumor by nephrectomy. We performed univariate and multivariable adjusted analysis to identify the effect of metastasectomy on overall survival (OS) and cancer-specific survival (CSS). RESULTS We included 483 patients with synchronous mRCC. Overall, 57 patients underwent complete and 96 incomplete metastasectomy, while 330 patients had no metastasectomy. The median OS was 17.9 and CSS 17.2 months for all patients. The median OS and the median CSS were 59.3 and 60.8 months for the complete, 21.9 and 25.1 for the incomplete, and 14.5 and 14.8 months for the no metastasectomy groups (p < 0.001 for differences). In both applied multivariable statistical models, the OS and CSS benefit from complete metastasectomy remained significant (hazard ratios (HRs) varied between 0.42 and 0.54, p < 0.001) compared with the no metastasectomy group. However, there was no improvement in survival estimates in the incomplete metastasectomy group compared with the no metastasectomy group (HRs varied between 1.04 and 1.10, p > 0.40). CONCLUSIONS Complete metastasectomy, when possible, can be considered as a treatment option for selected patients with synchronous mRCC who are fit for surgery. By contrast, we found no survival benefit from an incomplete metastasectomy suggesting that such procedures should not be performed for these patients.
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Affiliation(s)
- Lauri Laru
- Department of Urology, Oulu University Hospital, P.O. Box 21 FI-90029 OYS, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Hanna Ronkainen
- Department of Urology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pasi Ohtonen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Markku H Vaarala
- Department of Urology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Sadaghiani MS, Baskaran S, Gorin MA, Rowe SP, Provost JC, Teslenko I, Bilyk R, An H, Sheikhbahaei S. Utility of PSMA PET/CT in Staging and Restaging of Renal Cell Carcinoma: A Systematic Review and Metaanalysis. J Nucl Med 2024; 65:1007-1012. [PMID: 38782453 PMCID: PMC11218724 DOI: 10.2967/jnumed.124.267417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Prostate-specific membrane antigen (PSMA) is expressed in the neovasculature of multiple solid tumors, including renal cell carcinoma (RCC). Studies have demonstrated promising results on the utility of PSMA-targeted PET/CT imaging in RCC. This report aims to provide a systematic review and metaanalysis on the utility and detection rate of PSMA PET/CT imaging in staging or evaluation of primary RCC and restaging of metastatic or recurrent RCC. Methods: Searches were performed in PubMed, Embase, and abstract proceedings (last updated, August 2023). Studies that provided a lesion-level detection rate of PSMA radiotracers in staging or restaging of RCC were included in the metaanalysis. The overall pooled detection rate with a 95% CI was estimated, and subgroup analysis was performed when feasible. Results: Nine studies comprising 152 patients (133 clear cell RCC [ccRCC], 19 other RCC subtypes) were included in the metaanalysis. The pooled detection rate of PSMA PET/CT in evaluation of primary or metastatic RCC was estimated to be 0.83 (95% CI, 0.67-0.92). Subgroup analysis showed a pooled PSMA detection rate of 0.74 (95% CI, 0.57-0.86) in staging or evaluation of primary RCC lesions and 0.87 (95% CI, 0.73-0.95) in restaging of metastatic or recurrent RCC. Analysis based on the type of radiotracer showed a pooled detection rate of 0.85 (95% CI, 0.62-0.95) for 68Ga-based PSMA tracers and 0.92 (95% CI, 0.76-0.97) for 18F-DCFPyL PET/CT. Furthermore, in metastatic ccRCC, the available data support a significantly higher detection rate for 18F-DCFPyL PET/CT than for conventional imaging modalities (2 studies). Conclusion: Our preliminary results show that PSMA PET/CT could be a promising alternative imaging modality for evaluating RCC, particularly metastatic ccRCC. Large prospective studies are warranted to confirm clinical utility in the staging and restaging of RCC.
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Affiliation(s)
- Moe S Sadaghiani
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Steven P Rowe
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | | | | | - Hong An
- Lantheus, Bedford, Massachusetts
| | - Sara Sheikhbahaei
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland;
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3
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Baston C, Parosanu AI, Stanciu IM, Nitipir C. Metastatic Kidney Cancer: Does the Location of the Metastases Matter? Moving towards Personalized Therapy for Metastatic Renal Cell Carcinoma. Biomedicines 2024; 12:1111. [PMID: 38791072 PMCID: PMC11117570 DOI: 10.3390/biomedicines12051111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
The management of renal cell carcinoma (RCC) has been revolutionized over the past two decades with several practice-changing treatments. Treatment for RCC often requires a multimodal approach: Local treatment, such as surgery or ablation, is typically recommended for patients with localized tumors, while stage IV cancers often require both local and systemic therapy. The treatment of advanced RCC heavily relies on immunotherapy and targeted therapy, which are highly contingent upon histological subtypes. Despite years of research on biomarkers for RCC, the standard of care is to choose systemic therapy based on the risk profile according to the International Metastatic RCC Database Consortium and Memorial Sloan Kettering Cancer Centre models. However, many questions still need to be answered. Should we consider metastatic sites when deciding on treatment options for metastatic RCC? How do we choose between dual immunotherapy and combinations of immunotherapy and tyrosine kinase inhibitors? This review article aims to answer these unresolved questions surrounding the concept of personalized medicine.
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Affiliation(s)
- Catalin Baston
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (C.B.); (I.-M.S.); (C.N.)
- Department of Urology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Andreea Ioana Parosanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (C.B.); (I.-M.S.); (C.N.)
- Department of Oncology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Ioana-Miruna Stanciu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (C.B.); (I.-M.S.); (C.N.)
- Department of Oncology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Cornelia Nitipir
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (C.B.); (I.-M.S.); (C.N.)
- Department of Oncology, Elias University Emergency Hospital, 011461 Bucharest, Romania
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4
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Dai J, He B, Zhang Y, Zhang H, Hu X, Xu L, Ni Y, Zhang X, Sun G, Zeng H, Shen P, Liu Z. The survival benefit of metastasectomy for metastatic non-clear cell renal cell carcinoma: a retrospective cohort study. World J Urol 2024; 42:259. [PMID: 38662226 PMCID: PMC11045608 DOI: 10.1007/s00345-024-04973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE The aim of this study was to explore the benefit the metastasectomy for patients with metastatic non-clear cell carcinoma (non-ccRCC). METHODS This study enrolled 120 patients with confirmed metastatic non-ccRCC from the RCC database of our center from 2008 to 2021. Patients without metastasectomy were grouped as radical nephrectomy without metastasectomy patients. The clinical outcomes included overall survival (OS) and progression-free survival (PFS). Cox regression and Kaplan-Meier analyses were used to assess potential factors that predict clinical benefits from metastasectomy. RESULTS A total of 100 patients received radical nephrectomy alone, while the remaining 20 patients underwent both radical nephrectomy and metastasectomy. There was no significant difference in age between the two groups. Out of 100 patients who underwent radical nephrectomy, 60 were male, and out of 20 patients who had both radical nephrectomy and metastasectomy, 12 were male. Patients who underwent systemic therapy plus radical nephrectomy and metastasectomy had significantly better PFS (27.1 vs. 14.0, p = 0.032) and OS (67.3 vs. 24.0, p = 0.043) than those who underwent systemic therapy plus radical nephrectomy alone. Furthermore, for patients without liver metastasis (n = 54), systemic therapy plus radical nephrectomy and metastasectomy improved both PFS (p = 0.028) and OS (p = 0.043). Similarly, for patients with metachronous metastasis, systemic therapy plus radical nephrectomy and metastasectomy improved both PFS (p = 0.043) and OS (p = 0.032). None of the patients experienced serious perioperative complications (Clavien-Dindo Classification ≥ III grade). CONCLUSION Metastasectomy in patients with metastatic non-ccRCC may provide clinical benefits in terms of improved PFS and OS, especially in patients without liver metastasis and those with metachronous metastasis.
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Affiliation(s)
- Jindong Dai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ben He
- Department of Urology, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, 610014, Sichuan, China
| | - Yaowen Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Haoran Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xu Hu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lijing Xu
- Department of Urology, Institute of Urology, West China Xiamen Hospital, Sichuan University, Xiamen, 361000, China
| | - Yuchao Ni
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xingming Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guangxi Sun
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Pengfei Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Zhenhua Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Shimizu T, Miyake M, Nishimura N, Yoshida T, Itami Y, Tachibana A, Omori C, Oda Y, Kohashi M, Tomizawa M, Onishi K, Hori S, Morizawa Y, Dotoh D, Nakai Y, Torimoto K, Tanaka N, Fujimoto K. Impact of Complete Surgical Resection of Metastatic Lesions in Patients with Advanced Renal Cell Carcinoma in the Era of Tyrosine Kinase Inhibitors and Immune Checkpoint Inhibitors. Cancers (Basel) 2024; 16:841. [PMID: 38398232 PMCID: PMC10886671 DOI: 10.3390/cancers16040841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/08/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Complete metastasectomy (CM) in metastatic renal cell carcinoma (mRCC) has demonstrated efficacy in the cytokine era, but its effectiveness in the era of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) remains unclear. A multi-institutional database included clinicopathological data of 367 patients with mRCC. Patients were divided into two groups: the CM group and the non-CM group. These two groups were compared before and after propensity score matching (PSM). Cox proportional hazard models were used to detect factors associated with disease-free survival (DFS) and overall survival (OS) from mRCC diagnosis. The CM group showed a significant association with longer overall survival compared to the non-CM group in the PSM-unadjusted cohorts (p < 0.001, hazard ratio 0.49, 95% confidence interval 0.35-0.69), but no superiority was noted in the adjusted cohorts. The median DFS after CM was 24 months, with no significant differences based on relapse timing. Notably, the international metastatic RCC database consortium risk categories and metastatic burden were associated with DFS. This study supports the potential of CM in mRCC management during the TKI/ICI era, although limitations including sample size and selection bias need to be considered.
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Affiliation(s)
- Takuto Shimizu
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Nobutaka Nishimura
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Takanori Yoshida
- Department of Urology, Nara Prefecture Seiwa Medical Center, Ikoma, Nara 636-0802, Japan
| | - Yoshitaka Itami
- Department of Urology, Tane General Hospital, Osaka, Osaka 550-0025, Japan
| | - Akira Tachibana
- Department of Urology, Hoshigaoka Medical Center, Hirakata, Osaka 573-8511, Japan
| | - Chihiro Omori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
- Department of Urology, Nara Prefecture General Medical Center, Nara, Nara 630-8581, Japan
| | - Yuki Oda
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Mikiko Kohashi
- Department of Urology, Nara City Hospital, Nara, Nara 630-8305, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Kenta Onishi
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Daisuke Dotoh
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Nobumichi Tanaka
- Department of Prostate Brachytherapy, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
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Marconi L, Kuusk T, Capitanio U, Beisland C, Lam T, Pello SF, Stewart GD, Klatte T, Volpe A, Ljungberg B, Dabestani S, Bex A. Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups. EUR UROL SUPPL 2022; 47:65-72. [PMID: 36601038 PMCID: PMC9806698 DOI: 10.1016/j.euros.2022.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/16/2022] Open
Abstract
Background Retrospective comparative studies suggest a survival benefit after complete local treatment of recurrence (LTR) in renal cell carcinoma (RCC), which may be largely due to an indication bias. Objective To determine the role of LTR in a homogeneous population characterised by limited and potentially resectable recurrence. Design setting and participants RECUR is a protocol-based multicentre European registry capturing patient and tumour characteristics, risk of recurrence (RoR), recurrence patterns, and survival of those curatively treated for nonmetastatic RCC from 2006 to 2011. Per-protocol resectable disease (RD) recurrence was defined as (1) solitary metastases, (2) oligometastases, or (3) renal fossa or renal recurrence after radical or partial nephrectomy, respectively. Intervention Local treatment of recurrence. Outcome measurements and statistical analysis Overall survival (OS) and cancer-specific survival was compared in the RD population that underwent LTR versus no LTR. We constructed a multivariate model to predict risk factors for overall mortality and analysed the effect of LTR across RoR groups. Results and limitations Of 3039 patients with localised RCC treated with curative intent, 505 presented with recurrence, including 176 with RD. Of these patients, 97 underwent LTR and 79 no LTR. Patients in the LTR group were younger (64.3 [40-80] vs 69.2 [45-87] yr; p = 0.001). The median OS was 70.3 mo (95% confidence interval [CI] 58-82.6) versus 27.4 mo (95% CI 23.6-31.15) in the LTR versus no-LTR group (p < 0.001). After a multivariate analysis, having LTR (hazard ratio [HR] 0.37 [95% CI 0.2-0.6]), having low- versus high-risk RoR (HR 0.42 [95% CI [0.20-0.83]), and not having extra-abdominal/thoracic metastasis (HR 1.96 [95% CI 1.02-3.77]) were prognostic factors of longer OS. The LTR effect on survival was consistent across risk groups. OS HR for high, intermediate, and low risks were 0.36 (0.2-0.64), 0.27 (0.11-0.65), and 0.26 (0.08-0.8), respectively. Limitations include retrospective design. Conclusions This is the first study assessing the effectiveness of LTR in RCC in a comparable population with RD. This study supports the role of LTR across all RoR groups. Patient summary We assessed the effectiveness of local treatment of resectable recurrent renal cell carcinoma after surgical treatment of the primary kidney tumour. Local treatment of recurrence was associated with longer survival across groups with a risk of recurrence.
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Affiliation(s)
- Lorenzo Marconi
- Department of Urology and Renal Transplantation, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Teele Kuusk
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy,Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Christian Beisland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway,Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Thomas Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK,Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Grant D. Stewart
- Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tobias Klatte
- Department of Urology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Borje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Saeed Dabestani
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Malmö, Sweden
| | - Axel Bex
- Department of Urology, The Royal Free London NHS Foundation Trust, London, UK,Division of Surgery and Interventional Science, University College London, London, UK,Surgical Oncology Division, Urology Department, The Netherlands Cancer Institute, Amsterdam, The Netherlands,Corresponding author. Department of Urology, The Royal Free London NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; Surgical Oncology Division, Urology Department, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Stühler V, Herrmann L, Maas M, Walz S, Rausch S, Stenzl A, Bedke J. Prognostic impact of complete metastasectomy in metastatic renal cell carcinoma in the era of immuno-oncology-based combination therapies. World J Urol 2022; 40:1175-1183. [PMID: 35217885 PMCID: PMC9085676 DOI: 10.1007/s00345-022-03960-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Complete metastasectomy of renal cell carcinoma (RCC) is receding into the past due to the progress of immuno-oncology-based combinations (IO) in systemic therapy. The prognostic impact of curative intended complete metastasectomy vs. immediate IO-based therapy or tyrosine kinase inhibition (TKI) on progression-free survival (PFS) and cancer-specific survival (CSS) was investigated in the first-line setting. METHODS 205 patients with synchronous or metachronous metastasis received complete metastasectomy (n = 80) or systemic therapy (n = 125, TKI: 87, TKI-IO: 13, IO-IO: 25) as first-line therapy. The prognostic impact of these therapies was assessed using Cox regression and Kaplan-Meier analyses. RESULTS First-line complete metastasectomy significantly improved CSS compared to both TKI monotherapy (6.1 vs. 2.6 years, HR 0.45, p < 0.001) and IO-based combination therapy (IO-IO/TKI-IO, 6.1 vs. 3.5 years, HR 0.28, p = 0.007). Repetitive complete metastasectomy without ever receiving systemic therapy vs. systemic therapy in first-line significantly prolonged CSS (11.3 vs. 3.1 years, HR 0.34, p = 0.002). First-line complete metastasectomy and subsequent systemic therapy at tumor progression was associated with a significant CSS benefit vs. systemic therapy (5.8 vs. 3.1 years, HR 0.53, p = 0.003), also compared to IO-based combinations (5.8 vs. 3.5 years, HR 0.30, p = 0.017). Median PFS was improved by IO-based therapy compared to TKI monotherapy in the first-line setting (HR 0.61, p = 0.05), with maximal benefit of the TKI-IO combination vs. TKI monotherapy (HR 0.27, p = 0.01), as well as compared to PFS of complete metastasectomy (HR 0.34, p = 0.035). CONCLUSION Despite the progress of IO-based combination therapies in first line, complete metastasectomy remains an integral part of the multimodality treatment of metastatic RCC.
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Affiliation(s)
- Viktoria Stühler
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Lisa Herrmann
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Moritz Maas
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Simon Walz
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Jens Bedke
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany.
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8
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Reshaping Treatment Paradigms for Advanced Renal Cell Cancer Patients and Improving Patient Management : Optimal Management for Renal Cell Cancer Patients. Curr Treat Options Oncol 2022; 23:609-629. [PMID: 35316480 DOI: 10.1007/s11864-022-00966-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 12/24/2022]
Abstract
OPINION STATEMENT The treatment of renal cell carcinoma (RCC) is one of the great success stories in the field of oncology, which was revolutionized with the development of therapies aimed at disrupting crucial pathways. Tumor biology of RCC has provided insight into the disease through elucidation of the role of vascular endothelial growth-factor (VEGF) and the mammalian target of rapamycin (mTOR). Targeted agents against VEGF and mTOR, as well as agents targeting relevant immunomodulatory pathways, have shown clinical benefit for advanced disease. The targeted agents are highly effective in achieving a response and survival, particularly in high-risk patients. These include the vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) axitinib and cabozantinib, and programmed cell death 1 protein (PD-1) immune checkpoint inhibitors (ICI) nivolumab and pembrolizumab. There is a wealth of evidence investigating different therapeutic options and combinations for first-line treatment of advanced RCC including the CheckMate 214 study, KEYNOTE-426, JAVELIN Renal 101, and CheckMate 9ER. Dual ICI and combination agents targeting the programmed cell death protein 1/programmed cell death protein ligand 1 (PD1/PDL1) and VEGF, began to demonstrate superiority over previously accepted standards in advanced clear-cell RCC. Data from a number of clinical studies are available to help physicians with evidence-based decisions for the sequence of second-line and future treatments for patients with progressive RCC. In this review, we focus on essentials for clinicians treating patients with clear-cell RCC.
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9
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Brassetti A, Proietti F, Leonardo C, Simone G. The Value of Metastasectomy in Renal Cell Carcinoma in 2021. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Cao C, Shou J, Shi H, Jiang W, Kang X, Xie R, Shang B, Bi X, Zhang J, Zheng S, Zhou A, Li C, Ma J. Novel cut-off values of time from diagnosis to systematic therapy predict the overall survival and the efficacy of targeted therapy in renal cell carcinoma: A long-term, follow-up, retrospective study. Int J Urol 2021; 29:212-220. [PMID: 34847622 PMCID: PMC9299735 DOI: 10.1111/iju.14751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 11/08/2021] [Indexed: 12/25/2022]
Abstract
Objectives Metastatic renal cell carcinoma can occur synchronously or metachronously. We characterized the time from diagnosis to systematic therapy as a categorical variable to analyze its effect on the overall survival and first‐line treatment efficacy of metastatic renal cell carcinoma patients. Methods We initially enrolled 949 consecutive metastatic renal cell carcinoma patients treated with targeted therapies retrospectively from December 2005 to December 2019. X‐tile analysis was used to determine cut‐off values of time from diagnosis to systematic therapy referring to overall survival. Patients were divided into different groups based on the time from diagnosis to systematic therapy and then analyzed for survival. Results Of 358 eligible patients with metastatic renal cell carcinoma, 125 (34.9%) had synchronous metastases followed by cytoreductive nephrectomy, and 233 (65.1%) had metachronous metastases. A total of 28 patients received complete metastasectomy. Three optimal cut‐off values for the time from diagnosis to systematic therapy (months) – 1.1, 7.0 and 35.9 – were applied to divide the population into four groups: the synchro group (time from diagnosis to systematic therapy ≤1.0), early group (1.0 < time from diagnosis to systematic therapy ≤ 7.0), intermediate group (7.0 < time from diagnosis to systematic therapy < 36.0) and late group (time from diagnosis to systematic therapy ≥36.0). The targeted therapy‐related overall survival (P < 0.001) and progression‐free survival (P < 0.001) values were significantly different among the four groups. Patients with longer time from diagnosis to systematic therapy had better prognoses and promising efficacy of targeted therapy. With the prolongation of time from diagnosis to systematic therapy, complete metastasectomy was more likely to achieve and bring a better prognosis. Conclusions The time from diagnosis to systematic therapy impacts the survival of metastatic renal cell carcinoma patients treated with targeted therapy. The cutoff points of 1, 7 and 36 months were statistically significant. The statistical boundaries might be valuable in future model establishment.
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Affiliation(s)
- Chuanzhen Cao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhe Shi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weixing Jiang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangpeng Kang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruiyang Xie
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bingqing Shang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xingang Bi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shan Zheng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Aiping Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changling Li
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianhui Ma
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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11
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Singh M, Aryal V, Dangol AMS, Neupane K, Gurung B, Shrestha S, Tuladhar SM, Maskey S, Dhakal HP. Lung metastasis from renal cell carcinoma 16 years after nephrectomy: A case report and review of the literature. Clin Case Rep 2021; 9:e05033. [PMID: 34765208 PMCID: PMC8572333 DOI: 10.1002/ccr3.5033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/12/2021] [Accepted: 10/16/2021] [Indexed: 11/20/2022] Open
Abstract
Renal cell carcinoma can have lung metastasis even after a long interval of radical nephrectomy (16 years after nephrectomy in our case). If any pulmonary nodule is diagnosed with a history of RCC, pulmonary metastasis of RCC should be suspected and should be appropriately treated.
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Affiliation(s)
- Moushami Singh
- Department of Pathology and Laboratory MedicineNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Vinayak Aryal
- Department of Pathology and Laboratory MedicineNepal Cancer Hospital and Research CenterLalitpurNepal
| | | | - Karun Neupane
- Department of Internal MedicineJacobi Medical CenterBronxNew YorkUSA
| | - Banita Gurung
- Department of Pathology and Laboratory MedicineNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Suniti Shrestha
- Department of Pathology and Laboratory MedicineNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Sampurna Man Tuladhar
- Department of Cardiac and Thoracic SurgeryNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Swechha Maskey
- Department of Pathology and Laboratory MedicineNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Hari Prasad Dhakal
- Department of Pathology and Laboratory MedicineNepal Cancer Hospital and Research CenterLalitpurNepal
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12
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Yoshikawa Y, Yamada Y, Emi M, Atanesyan L, Smout J, de Groot K, Savola S, Nakanishi-Shinkai Y, Kanematsu A, Nojima M, Ohmuraya M, Hashimoto-Tamaoki T, Yamamoto S. Risk prediction for metastasis of clear cell renal cell carcinoma using digital multiplex ligation-dependent probe amplification. Cancer Sci 2021; 113:297-307. [PMID: 34687579 PMCID: PMC8748218 DOI: 10.1111/cas.15170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022] Open
Abstract
Precise quantification of copy‐number alterations (CNAs) in a tumor genome is difficult. We have applied a comprehensive copy‐number analysis method, digital multiplex ligation‐dependent probe amplification (digitalMLPA), for targeted gene copy‐number analysis in clear cell renal cell carcinoma (ccRCC). Copy‐number status of all chromosomal arms and 11 genes was determined in 60 ccRCC samples. Chromosome 3p loss and 5q gain, known as early changes in ccRCC development, as well as losses at 9p and 14q were detected in 56/60 (93.3%), 31/60 (51.7%), 11/60 (18.3%), and 33/60 (55%), respectively. Through gene expression analysis, a significant positive correlation was detected in terms of 14q loss determined using digitalMLPA and downregulation of mRNA expression ratios with HIF1A and L2HGDH (P = .0253 and .0117, respectively). Patients with early metastasis (<1 y) (n = 18) showed CNAs in 6 arms (in median), whereas metastasis‐free patients (n = 34) showed those in significantly less arms (3 arms in median) (P = .0289). In particular, biallelic deletion of CDKN2A/2B was associated with multiple CNAs (≥7 arms) in 3 tumors. Together with sequence‐level mutations in genes VHL, PBRM1, SETD2, and BAP1, we performed multiple correspondence analysis, which identified the association of 9p loss and 4q loss with early metastasis (both P < .05). This analysis indicated the association of 4p loss and 1p loss with poor survival (both, P < .05). These findings suggest that CNAs have essential roles in aggressiveness of ccRCC. We showed that our approach of measuring CNA through digitalMLPA will facilitate the selection of patients who may develop metastasis.
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Affiliation(s)
- Yoshie Yoshikawa
- Department of Genetics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yusuke Yamada
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Mitsuru Emi
- Department of Genetics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Lilit Atanesyan
- Oncogenetics Department, MRC Holland, Amsterdam, The Netherlands
| | - Jan Smout
- Oncogenetics Department, MRC Holland, Amsterdam, The Netherlands
| | - Karel de Groot
- Bioinformatics Department, MRC Holland, Amsterdam, The Netherlands
| | - Suvi Savola
- Oncogenetics Department, MRC Holland, Amsterdam, The Netherlands
| | | | - Akihiro Kanematsu
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Michio Nojima
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masaki Ohmuraya
- Department of Genetics, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
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13
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Chanez B, Caillol F, Ratone JP, Pesenti C, Rochigneux P, Pignot G, Thomassin J, Brunelle S, Walz J, Salem N, Giovannini M, Gravis G. Endoscopic Ultrasound-Guided Radiofrequency Ablation as an Future Alternative to Pancreatectomy for Pancreatic Metastases from Renal Cell Carcinoma: A Prospective Study. Cancers (Basel) 2021; 13:cancers13215267. [PMID: 34771431 PMCID: PMC8582413 DOI: 10.3390/cancers13215267] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/04/2021] [Accepted: 10/15/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Glandular metastases and more precisely pancreatic metastases (PM) from renal cell carcinoma (mRCC) are associated with a long survival. Focal treatment in order to control oligo-metastatic disease and avoid systemic therapy is a standard in RCC. However, pancreatic radiofrequency ablation remains a marginal and under evaluated technic. Standard treatment remains pancreatectomy with hazardous outcomes. We report here the largest series of endoscopic radiofrequency ablation (EUS-RFA) on PM for patient treated at Institut Paoli-Calmettes for a mRCC. Patients with progressive PM was treated under general anesthesia with an ultrasound guided endoscopic radiofrequency ablation procedure then followed by CT-scan. We prospectively included 12 patients, median age was 70.5 years old and median size and number of PM at inclusion was 17 mm and 1 respectively. All 26 procedures performed went as planned and no immediate complications were experienced. After 27.7 months of follow-up, the 6- and 12-month focal control rates were 84% and 73% respectively. Two severe complications occurred after EUS-RFA but were totally resolved after specific treatment. In total, EUS-RFA is feasible and displayed an excellent focal control and should be integrated in the arsenal to treat PM from mRCC in order to spare systemic therapy and/or pancreatic surgery. Abstract Background: Pancreatic metastases (PM) from renal cell carcinoma (RCC) are rare, are associated with favorable outcomes and are usually handled by surgery or VEGFR inhibitors, which both have side effects. Endoscopic Ultrasound (EUS)-guided radiofrequency ablation (RFA) is an innovative approach to treat focally deep metastases and could be a relevant technique to control PM from RCC. Methods: This monocentric, prospective study aimed to evaluate the safety and efficacy of EUS-RFA to treat PM. We included patients with confirmed and progressive PM from RCC. PM was ablated under general anesthesia with a linear EUS scope and a EUS-RFA 19-gauge needle electrode placed into the tumor. Results: Twelve patients from Paoli-Calmettes Institute were recruited between May 2017 and December 2019. Median age was 70.5 years (range 61–75), 50% were female, 100% were ECOG 0–1. At inclusion, mean PM size was 17 mm (range 3–35 mm); and all were progressive before EUS-RFA. Seven patients had EUS-RFA as the only treatment for RCC. We performed 26 EUS-RFA procedures and 21 PM was ablated. Median follow up was 27.7 months (range 6.4–57.1). For evaluable PM, the 6- and 12-month focal control rates were 84% and 73% respectively. One patient treated with TKI developed a paraduodenal abscess 2 months after EUS-RFA and another patient with biliary stent developed hepatic abscesses few days after EUS-RFA. No other severe side effects were experienced. Conclusions: in this series, which is the largest ever reported, we showed that EUS-RFA is feasible and yields an excellent local control rate for PM from mRCC. With manageable complications, it could be a valuable alternative to pancreatic surgery in well-selected patients.
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Affiliation(s)
- Brice Chanez
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (B.C.); (P.R.)
- Centre de Recherche en Cancérologie de Marseille, INSERM UMR1068, CNRS UMR7258, Institut Paoli-Calmettes, 13009 Marseille, France
- Aix Marseille Université, 13010 Marseille, France
| | - Fabrice Caillol
- Department of Gastroenterology and Endoscopy, Institut Paoli-Calmettes, 13009 Marseille, France; (F.C.); (J.-P.R.); (C.P.); (M.G.)
| | - Jean-Philippe Ratone
- Department of Gastroenterology and Endoscopy, Institut Paoli-Calmettes, 13009 Marseille, France; (F.C.); (J.-P.R.); (C.P.); (M.G.)
| | - Christian Pesenti
- Department of Gastroenterology and Endoscopy, Institut Paoli-Calmettes, 13009 Marseille, France; (F.C.); (J.-P.R.); (C.P.); (M.G.)
| | - Philippe Rochigneux
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (B.C.); (P.R.)
- Centre de Recherche en Cancérologie de Marseille, INSERM UMR1068, CNRS UMR7258, Institut Paoli-Calmettes, 13009 Marseille, France
- Aix Marseille Université, 13010 Marseille, France
| | - Géraldine Pignot
- Department of Urologic Surgery, Institut Paoli-Calmettes, 13009 Marseille, France; (G.P.); (J.W.)
| | - Jeanne Thomassin
- Department of Pathology, Institut Paoli-Calmettes, 13009 Marseille, France;
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, 13009 Marseille, France;
| | - Jochen Walz
- Department of Urologic Surgery, Institut Paoli-Calmettes, 13009 Marseille, France; (G.P.); (J.W.)
| | - Naji Salem
- Department of Radiotherapy, Institut Paoli-Calmettes, 13009 Marseille, France;
| | - Marc Giovannini
- Department of Gastroenterology and Endoscopy, Institut Paoli-Calmettes, 13009 Marseille, France; (F.C.); (J.-P.R.); (C.P.); (M.G.)
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (B.C.); (P.R.)
- Centre de Recherche en Cancérologie de Marseille, INSERM UMR1068, CNRS UMR7258, Institut Paoli-Calmettes, 13009 Marseille, France
- Correspondence: ; Tel.: +33-4-91-22-37-36
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14
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Cytoreductive Nephrectomy in the Management of Metastatic Renal Cell Carcinoma: Is There Still a Debate? Curr Urol Rep 2021; 22:54. [PMID: 34654989 DOI: 10.1007/s11934-021-01073-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW The aim of this review was to summarize the evidence on the current role of cytoreductive nephrectomy (CN) in patients with metastatic renal cell carcinoma (mRCC). RECENT FINDINGS Since the advent of systemic targeted therapies for mRCC treatment, the role of CN has been questioned. Several retrospective observational studies demonstrated a therapeutic benefit for CN, while recent prospective randomized trials have challenged this evidence. As such, patient selection has become of paramount importance in this setting. The role of CN on mRCC treatment is still object of debate. In carefully selected patients, CN remains an important option as a component of a multimodal therapeutic approach. As systemic therapies for mRCC continue to evolve, future trials are needed to evaluate the benefits and limits of CN in the immunotherapy era, tailoring the treatment sequence and selecting the patients who are most likely to benefit from surgical interventions.
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15
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Kim SH, Choi MG, Shin JH, Kim YA, Chung J. A Real-World, Population-Based Retrospective Analysis of Therapeutic Survival for Recurrent Localized Renal Cell Carcinoma After Nephrectomy. Front Oncol 2021; 11:693831. [PMID: 34568023 PMCID: PMC8456083 DOI: 10.3389/fonc.2021.693831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/16/2021] [Indexed: 01/22/2023] Open
Abstract
We retrospectively analyzed therapeutic strategies and risk factors for overall survival (OS) in disease recurrence following curative nephrectomy for localized renal cell carcinoma (loRCC) using the Korean National Cancer Registry Database. We selected 1295 recurrent loRCC patients who underwent either partial or radical nephrectomy from 2007-2013. Patients were excluded for age <19 years, secondary RCC, multiple primary tumors, other SEER stages except for a localized or regional stage, postoperative recurrence within 3-month, and non-nephrectomized cases. Four therapeutic groups were statistically analyzed for OS and risk factors: surgery (OP, 12.0%), other systemic therapy (OST, 59.5%), radiotherapy (RT, 2.8%), and targeted therapy (TT, 25.8%). The overall mortality rate for recurrent loRCC was 32.5%, including 82.4% for RCC-related deaths. The baseline comparison among groups showed statistical differences for the diagnostic age of cancer and the SEER stage (p<0.05). Multivariate analysis of OS showed significance for the TT (hazard ratio [HR]: 6.27), OST (HR: 7.05), and RT (HR: 7.47) groups compared with the OP group, along with significance for the sex, SEER stage, and the time from nephrectomy to treatment for disease recurrence (p<0.05). The median OS curve showed a significantly better OS in the OP group (54.9 months) compared with the TT, OST, and RT groups (41.7, 42.9, and 38.0 months, respectively; p<0.001). In conclusion, the surgery-treated group had the best OS among the different therapeutic strategies for recurrent loRCC after nephrectomy, and the importance of the time from nephrectomy to secondary treatment was a significant prognostic factor.
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Affiliation(s)
- Sung Han Kim
- Department of Urology, Center for Urologic Cancer, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Min Gee Choi
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Ji Hye Shin
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Young-Ae Kim
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Jinsoo Chung
- Department of Urology, Center for Urologic Cancer, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
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16
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Suzuki K, Hara T, Terakawa T, Furukawa J, Harada K, Hinata N, Nakano Y, Fujisawa M. The Efficacy of Surgical Metastasectomy for Solitary Metastasis of Renal Cell Carcinoma. Urol Int 2021; 106:397-403. [PMID: 34134119 DOI: 10.1159/000516679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with solitary metastasis of renal cell carcinoma (RCC) have shown to be ideal candidates for surgical metastasectomy (SM). However, whether SM will show more benefit than systemic therapy remains unclear. METHODS We included 73 patients treated for solitary metastasis after nephrectomy at our institute from April 2008 to December 2018. We compared the clinical outcomes between the SM (n = 29) and no-SM (n = 44) group which were treated with only systemic therapy. RESULTS Eleven of 29 patients in the SM group received presurgical targeted therapy (PTT). Although 13 of 29 patients in the SM group showed recurrence during the study period, a Cox proportional hazards model showed that SM was significantly associated with a favorable overall survival (hazard ratio: 0.18; p = 0.007). Patients receiving PTT prior to SM showed a longer recurrence-free survival after SM in comparison to those who underwent SM without PTT (median: not reached vs. 27.7 months; p = 0.009). CONCLUSIONS If resection is feasible, SM may be beneficial for patients with solitary metastasis of RCC, and we showed the possibility that PTT prior to SM may be effective for avoiding recurrence after SM. Further large-scale prospective studies are needed to clarify the ideal treatment strategy for metastatic RCC.
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Affiliation(s)
- Kotaro Suzuki
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takuto Hara
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoaki Terakawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Furukawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichi Harada
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuyuki Hinata
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuzo Nakano
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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17
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Kato S, Demura S, Murakami H, Yoshioka K, Shinmura K, Yokogawa N, Shimizu T, Kawahara N, Tsuchiya H. Clinical outcomes and prognostic factors following the surgical resection of renal cell carcinoma spinal metastases. Cancer Sci 2021; 112:2416-2425. [PMID: 33780597 PMCID: PMC8177761 DOI: 10.1111/cas.14902] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022] Open
Abstract
The efficacy of surgical resection in metastatic renal cell carcinoma is an active and important research field in the postcytokine era. Bone metastases, especially in the spine, compromise patient performance status. Metastasectomy is indicated, if feasible, because it helps to achieve the best clinical outcomes possible compared with other treatments. This study examined the postoperative survival and prognostic factors in patients who underwent metastasectomy of spinal lesions. The retrospective study included 65 consecutive patients with metastatic renal cell carcinomas who were operated on by spinal metastasectomy between 1995 and 2017 at our institution. The cancer‐specific survival times from the first spinal metastasectomy to death or the last follow‐up (≥3 years) were determined using Kaplan‐Meier analysis. Potential factors influencing survival were analyzed using Cox proportional hazard models. Planned surgical resection of all the spine tumors was achieved in all patients. Of these, 38 had complete metastasectomy of all visible metastases, including extraspinal lesions. In all patients, the estimated median cancer‐specific survival time was 100 months. The 3‐, 5‐, and 10‐year cancer‐specific survival rates were 77%, 62%, and 48%, respectively. The survival times after spinal metastasectomy were similar in both cytokine and postcytokine groups. In multivariate analyses, postoperative disability, the coexistence of liver metastases, multiple spinal metastases, and incomplete metastasectomy were significant risk factors associated with short‐term survival. Complete metastasectomy, including extraspinal metastases, was associated with improved cancer‐specific survival. Proper patient selection and complete metastasectomy provide a better prognosis in metastatic renal cell carcinoma patients.
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Affiliation(s)
- Satoshi Kato
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Katsuhito Yoshioka
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kazuya Shinmura
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Takaki Shimizu
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Norio Kawahara
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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18
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Leigh N, Hawkins WG. Elucidating the Efficacy of Pancreatectomy for Renal Cell Metastases Remains Problematic. Ann Surg Oncol 2021; 28:2946-2948. [PMID: 33660131 DOI: 10.1245/s10434-021-09652-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Natasha Leigh
- Department of Surgery, Barnes-Jewish Hospital/Washington University Medical Center and Siteman Cancer Center, St Louis, MO, 63110, USA
| | - William G Hawkins
- Department of Surgery, Barnes-Jewish Hospital/Washington University Medical Center and Siteman Cancer Center, St Louis, MO, 63110, USA.
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19
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Yue G, Deyu L, Lianyuan T, Fengmin S, Mei G, Yajun H, Wenwen Z, Lei Y. Clinical features and prognostic factors of patients with metastatic renal cell carcinoma stratified by age. Aging (Albany NY) 2021; 13:8290-8305. [PMID: 33686965 PMCID: PMC8034891 DOI: 10.18632/aging.202637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
This study compared the clinicopathological characteristics and survival of patients with metastatic renal cell carcinoma (mRCC) stratified by age to identify clinical features and prognostic factors. Patients with renal cell carcinoma (RCC) between 2010 and 2015 were identified from the Surveillance, Epidemiology and End Results database. Age was an independent prognostic factor for patients with RCC, mRCC, mRCC of clear cell renal cell carcinoma and lung-related metastases. There were many significant differences between the younger and older groups, including differences in marital status, race, sex, year of diagnosis, histology grade, laterality, T stage, N stage, tumor size, type of treatment, including surgery, radiation or chemotherapy, and pattern of organic metastasis to the liver, lung, or brain (P<0.05). Moreover, different natural metastasis patterns and poorer overall survival were observed in the older group compared with the younger group (P<0.05). Parameters, including marital status, sex, year of diagnosis, histological grade, N stage, surgery, chemotherapy, lung metastasis and liver metastasis, were independent prognostic factors for elderly patients (P<0.05). Age plays a significant role in mRCC, and elderly patients with mRCC are a special group of individuals whose clinical characteristics and prognostic factors are different from those of younger patients; therefore, these patients require special attention.
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Affiliation(s)
- Gu Yue
- Department of Nephrology, Henan Provincial People's Hospital, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan, China
| | - Li Deyu
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University Peoples Hospital, Zhengzhou 450003, Henan, China
| | - Tao Lianyuan
- Department of Hepatobiliary Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University Peoples Hospital, Zhengzhou 450003, Henan, China
| | - Shao Fengmin
- Department of Nephrology, Henan Provincial People's Hospital, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan, China
| | - Gao Mei
- Department of Nephrology, Henan Provincial People's Hospital, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan, China
| | - Huang Yajun
- Department of Nephrology, Henan Provincial People's Hospital, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan, China
| | - Zhang Wenwen
- Department of Nephrology, Henan Provincial People's Hospital, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan, China
| | - Yan Lei
- Department of Nephrology, Henan Provincial People's Hospital, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan, China
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De Raffele E, Mirarchi M, Casadei R, Ricci C, Brunocilla E, Minni F. Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature. World J Clin Cases 2020; 8:4450-4465. [PMID: 33083404 PMCID: PMC7559688 DOI: 10.12998/wjcc.v8.i19.4450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/31/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The therapeutic approach of metastatic renal cell carcinoma (RCC) represents a real challenge for clinicians, because of the variable clinical course; the recent availability of numerous targeted therapies that have significantly improved overall oncological results, but still with a low percentage of complete responses; and the increasing role of metastasectomy (MSX) as an effective strategy to achieve a durable cure, or at least defer initiation of systemic therapies, in selected patients and in the context of multimodality treatment strategies.
CASE SUMMARY We report here the case of a 40-year-old man who was referred to our unit in November 2004 with lung and mediastinal lymph nodes metastases identified during periodic surveillance 6 years after a radical nephrectomy for RCC; he underwent MSX of multiple lung nodules and mediastinal lymphadenectomy, with subsequent systemic therapy with Fluorouracil, Interferon-alpha and Interleukin 2. The subsequent clinical course was characterized by multiple sequential abdominal and thoracic recurrences, successfully treated with multiple systemic treatments, repeated local treatments, including two pancreatic resections, conservative resection and ablation of multiple bilobar liver metastases, resection and stereotactic body radiotherapy of multiple lung metastases. He is alive without evidence of recurrence 20 years after initial nephrectomy and sequential treatment of recurrences in multiple sites, including resection of more than 38 metastases, and 5 years after his last MSX.
CONCLUSION This case highlights that effective multimodality therapeutic strategies, including multiple systemic treatments and iterative aggressive surgical resection, can be safely performed with long-term survival in selected patients with multiple metachronous sequential metastases from RCC.
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Affiliation(s)
- Emilio De Raffele
- Dipartimento dell'Apparato Digerente, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna 40138, Italy
| | - Mariateresa Mirarchi
- Dipartimento Strutturale Chirurgico, Ospedale SS Antonio e Margherita, Tortona (AL) 15057, Italy
| | - Riccardo Casadei
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna 40138, Italy
| | - Claudio Ricci
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna 40138, Italy
| | - Eugenio Brunocilla
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale (DIMES), Alma Mater Studiorum, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna 40138, Italy
| | - Francesco Minni
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna 40138, Italy
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Raffele ED, Mirarchi M, Casadei R, Ricci C, Brunocilla E, Minni F. Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i19.4451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Yuasa T. A novel classification for local recurrence after surgical removal of renal cell cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:970. [PMID: 32953770 PMCID: PMC7475408 DOI: 10.21037/atm.2020.03.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Takeshi Yuasa
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
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Cytoreductive Nephrectomy in Patients Presenting With Advanced Disease: Have We Finally Answered the Question? ACTA ACUST UNITED AC 2020; 26:382-389. [PMID: 32947306 DOI: 10.1097/ppo.0000000000000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Determining the appropriate patients for cytoreductive nephrectomy (CN) has evolved with the integration of more effective systemic therapies for patients with metastatic renal cell carcinoma (mRCC). While previously considered to be first-line therapy for mRCC, CN has not demonstrated a significant survival advantage over systemic therapy in more recent randomized trials when compared with targeted therapy. Conversely, multiple observational studies demonstrate a therapeutic benefit for CN. This review synthesizes the current literature regarding patient selection for CN and further evaluates the role of CN in the current era of immune checkpoint inhibitor therapy. With careful patient selection, CN maintains an important role in the management of mRCC patients.
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Bian Z, Meng J, Niu Q, Jin X, Wang J, Feng X, Che H, Zhou J, Zhang L, Zhang M, Liang C. Prognostic Role of Prothrombin Time Activity, Prothrombin Time, Albumin/Globulin Ratio, Platelets, Sex, and Fibrinogen in Predicting Recurrence-Free Survival Time of Renal Cancer. Cancer Manag Res 2020; 12:8481-8490. [PMID: 32982441 PMCID: PMC7505717 DOI: 10.2147/cmar.s264856] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/25/2020] [Indexed: 12/22/2022] Open
Abstract
Background To help with the clinical practice of renal cancer patients, prognostic models are urgently warranted. We hunted and identified prognostic variables associated with recurrence-free survival (RFS) for renal cancer patients. Patients and Methods In this retrospective study, 187 renal cancer patients who had received curative radical/partial nephrectomy between November 2011 and January 2017 were enrolled in the current study. These patients were randomly split into the training (n = 95) and validation sets (n = 92) by the ratio of 1:1. Univariate and multivariable Cox regression analyses were used to establish the nomogram, which was then evaluated by receiver operating characteristic (ROC) and Kaplan-Meier (K-M) analyses. Results Patient characteristics and outcomes were well balanced between the training and validation sets; the median RFS values were 54.1 months and 58.9 months for the training and validation cohorts, respectively. The final nomogram included six independent prognostic variables (prothrombin time (%), prothrombin time (second), albumin/globulin ratio, platelets, sex and fibrinogen). The mean values of RFS for the low- and high-risk groups defined by a prognostic formula were 56.22 ± 18.50 months and 49.54 ± 23.57 months, respectively, in the training cohort and were 59.00 ± 19.50 months and 53.32 ± 19.95 months, respectively, in the validation cohort. The significance and stability of the model were tested by the time-dependent K-M model and ROC curves, respectively. Conclusion Our validated prognostic model incorporates variables routinely collected from renal cancer patients, identifying subsets of patients with different survival outcomes, which provides useful information for patient care and clinical trial design.
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Affiliation(s)
- Zichen Bian
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University; The Institute of Urology, Anhui Medical University, Hefei, People's Republic of China
| | - Jialin Meng
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University; The Institute of Urology, Anhui Medical University, Hefei, People's Republic of China
| | - Qingsong Niu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University; The Institute of Urology, Anhui Medical University, Hefei, People's Republic of China
| | - Xiaoyan Jin
- The Second Clinical College of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Jinian Wang
- Clinical Skills Training Center, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, People's Republic of China
| | - Xingliang Feng
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University; The Institute of Urology, Anhui Medical University, Hefei, People's Republic of China
| | - Hong Che
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Jun Zhou
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University; The Institute of Urology, Anhui Medical University, Hefei, People's Republic of China
| | - Li Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University; The Institute of Urology, Anhui Medical University, Hefei, People's Republic of China
| | - Meng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University; The Institute of Urology, Anhui Medical University, Hefei, People's Republic of China.,Institute of Urology of Shenzhen University, The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group, Shenzhen 518000, People's Republic of China
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University; The Institute of Urology, Anhui Medical University, Hefei, People's Republic of China
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Ishihara H, Takagi T, Kondo T, Fukuda H, Tachibana H, Yoshida K, Iizuka J, Kobayashi H, Ishida H, Tanabe K. Prognostic impact of metastasectomy in renal cell carcinoma in the postcytokine therapy era. Urol Oncol 2020; 39:77.e17-77.e25. [PMID: 32863124 DOI: 10.1016/j.urolonc.2020.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To explore the real-world data regarding survival following metastasectomy (MS) for renal cell carcinoma (RCC) in the postcytokine therapy era. PATIENTS AND METHODS Patients diagnosed with metastatic renal cell carcinoma (mRCC) between January 2008 and December 2018 at our institutions were retrospectively evaluated. The patients were classified into three groups according to their MS status: (1) complete MS (cMS), (2) incomplete MS (icMS), and (3) without MS (nonMS). Factors for overall survival (OS) after diagnosis were analyzed. RESULTS Overall, 314 patients were evaluated. During the follow-up period (median: 25.3 months), a total of 98 patients (31.2%) underwent at least one MS. The cMS group (n = 45, 14.3%) had a significantly longer OS (median: not reached [N.R.]) than the icMS (n = 53, 16.9%) (81.5 months, P= 0.0042) and nonMS groups (28.1 months, P< 0.0001). The icMS group had a significantly longer OS than the nonMS group did (P= 0.0010). Multivariate analysis showed that the MS status was an independent factor for OS (cMS vs. nonMS: P= 0.0004; icMS vs. nonMS: P= 0.0176), together with histopathological type, International Metastatic Renal Cell Carcinoma Database Consortium risk, liver metastasis status, and prior nephrectomy status (all, P< 0.05). In addition, the OS was comparable throughout the eras of systemic therapy (early molecular-targeted therapy, late molecular-targeted therapy, and immune checkpoint inhibitor eras) in the MS group (median: 121.9 vs. N.R. vs. N.R. months, P= 0.948). CONCLUSIONS MS, especially cMS improved survival in selected patients with mRCC in the postcytokine therapy era. In addition, MS still plays a significant role in the current systemic therapy.
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Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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The long noncoding RNA EMBP1 inhibits the tumor suppressor miR-9-5p and promotes renal cell carcinoma tumorigenesis. Nefrologia 2020; 40:429-439. [DOI: 10.1016/j.nefro.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/04/2019] [Accepted: 12/15/2019] [Indexed: 12/26/2022] Open
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Dr Hall B, Abel EJ. The Evolving Role of Metastasectomy for Patients with Metastatic Renal Cell Carcinoma. Urol Clin North Am 2020; 47:379-388. [PMID: 32600539 DOI: 10.1016/j.ucl.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Surgical metastasectomy continues to be utilized for patients with solitary or low-volume metastatic renal cell carcinoma (mRCC). Although few high-quality data are available to evaluate outcomes, local treatment is recommended when feasible because it may allow a subset of patients to delay or avoid systemic treatments. With the development of improved mRCC therapies, utilization of metastasectomy has increased because most patients have incomplete responses to systemic treatment of their metastases. This review discusses the rationale and history of metastasectomy, trends in utilization, prognostic factors for patient selection, site-specific considerations, alternatives for nonsurgical local treatment, and risk of morbidity associated with metastasectomy.
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Affiliation(s)
- Bryan Dr Hall
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA
| | - Edwin Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA.
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Badran A, Elshenawy MA, Shahin A, Aljubran A, Alzahrani A, Eldali A, Bazarbashi S. Efficacy and Prognostic Factors of Sunitinib as First-Line Therapy for Patients With Metastatic Renal Cell Carcinoma in an Arab Population. JCO Glob Oncol 2020; 6:19-26. [PMID: 32031432 PMCID: PMC6998020 DOI: 10.1200/jgo.19.00111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Antiangiogenic tyrosine kinase inhibitors have been the mainstay first-line therapy for metastatic renal cell carcinoma (mRCC). We reviewed the efficacy of first-line therapy with sunitinib in patients with mRCC in an Arab population. METHODS Medical records of patients with mRCC treated at a tertiary care center in Saudi Arabia, during the period from 2007 to 2016, were reviewed. Demographic data, treatment received, response, and prognostic factors were analyzed. RESULTS Fifty-five patients who received sunitinib were identified. The median age was 60 years (range, 18 to 78 years), and 42 of the 55 patients were men (76.3%). International Metastatic RCC Diagnostic Consortium prognostic scores for favorable/intermediate/poor were 14.5%/43.6%/38.2%, respectively. The median performance status was 1, and the median Charlson comorbidity index score was 9. Thirty-seven patients (67.2%) had cytoreductive nephrectomy. Thirty-seven patients (67.2%) had clear cell histology. Twenty-two patients (40%) underwent dose reduction. Twenty-seven patients (49%) received second-line therapy, and seven patients (12.7%) received third-line therapy. Response rates were complete response in one patient (1.8%), partial response in 17 (30.9%), stable disease in 10 (18.1), and disease progression in 20 (36.3%). Progression-free survival (PFS) and overall survival (OS) were 6.0 and 24.7 months, respectively. Univariate analysis showed statistically improved PFS for dose reduction (P = .015) and the development of hypothyroidism (P = .03). It also showed statistically improved OS for dose reduction (P = .035), hypothyroidism (P = .0002), and cytoreductive nephrectomy (P = .0052). Multivariate analysis showed statistically improved PFS for dose reduction (P = .01) and OS for development of hypothyroidism (P = .007). CONCLUSION Our data for sunitinib in mRCC show significantly lower PFS than expected. The absence of prognostic value of the International Metastatic RCC Diagnostic Consortium scoring system and pathologic subtype warrant further investigation and possible inclusion of genetic scoring in this ethnic group of patients.
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Affiliation(s)
- Ahmed Badran
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud A. Elshenawy
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - Amgad Shahin
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ali Aljubran
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Alzahrani
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdelmoneim Eldali
- Department of Biostatistics, Epidemiology and Scientific Computing, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Shouki Bazarbashi, MBBS, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; e-mail:
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Procopio G, Apollonio G, Cognetti F, Miceli R, Milella M, Mosca A, Chiuri VE, Bearz A, Morelli F, Ortega C, Atzori F, Donini M, Ratta R, Raimondi A, Claps M, Martinetti A, Capitanio U, de Braud FG, Cappelletti V, Verzoni E. Sorafenib Versus Observation Following Radical Metastasectomy for Clear-cell Renal Cell Carcinoma: Results from the Phase 2 Randomized Open-label RESORT Study. Eur Urol Oncol 2019; 2:699-707. [PMID: 31542243 DOI: 10.1016/j.euo.2019.08.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/21/2019] [Accepted: 08/30/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND In selected metastatic renal cell carcinoma (mRCC) patients, radical metastasectomy followed by observation is a potential strategy. It is still to be defined whether systemic therapy should be administered following metastasectomy. OBJECTIVE To assess the potential benefit of postoperative treatment with sorafenib compared with observation alone after radical metastasectomy in mRCC patients. DESIGN, SETTING, AND PARTICIPANTS The RESORT trial was a multicenter, randomized, open-label, phase 2 study conducted between November 2012 and November 2017 in Italy. Patients with clear-cell mRCC pretreated with nephrectomy and undergoing radical metastasectomy (three or fewer lesions) were eligible for the study. Patients were randomized (1:1) within 12 wk from metastasectomy to sorafenib (standard dose 400 mg twice daily) or observation for a maximum of 52 wk. Stratification factors were interval from nephrectomy, site, and number of lesions. Overall, 76 patients were screened and 69 were randomized: 33 were assigned to sorafenib and 36 to observation. The primary endpoint was recurrence-free survival (RFS). Secondary endpoints were overall survival and the safety profile. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS RFS curves were estimated with the Kaplan-Meier method, and the log-rank test was used to statistically compare the curves. RESULTS AND LIMITATIONS At a median follow-up of 38 mo, median RFS was 37 mo (95% confidence interval [CI] 20-not available [NA]) in the observation arm versus 21 mo (95% CI 11-NA) in the sorafenib arm (log-rank test p = 0.404), with 12-, 24-, and 36-mo RFS probability of 74% versus 63%, 59% versus 49%, and 50% versus 41%, respectively, in the observation versus the sorafenib arm. Any-grade adverse event (AE) rates were 84% in the sorafenib arm and 31% in the observation arm; grade ≥3 AE rates were 22% and 3% in the sorafenib and the observation arm, respectively, with a rate of treatment discontinuation for AEs of 19% in the sorafenib arm. CONCLUSIONS This prospective study showed that systemic treatment with sorafenib did not increase RFS as compared with observation in mRCC patients following radical metastasectomy. PATIENT SUMMARY This article reports the clinical outcome of patients with metastatic renal cell carcinoma treated with sorafenib or managed with an observation-alone strategy after the radical surgery of metastases. We found that sorafenib did not improve the patient outcome in terms of relapse-free survival in this selected population.
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Affiliation(s)
- Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Giulia Apollonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Cognetti
- Medical Oncology Department, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Rosalba Miceli
- Department of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Milella
- Medical Oncology Department, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Alessandra Mosca
- Department of Oncology, Maggiore Della Carità University Hospital, Novara, Italy
| | | | - Alessandra Bearz
- Medical Oncology Department, National Cancer Institute, Aviano, Italy
| | - Franco Morelli
- Medical Oncology Department, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Cinzia Ortega
- Medical Oncology Department, Istituto per la Ricerca e la Cura del Cancro di Candiolo, Torino, Italy
| | - Francesco Atzori
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Maddalena Donini
- Medical Oncology Department, Ospedale di Cremona, Cremona, Italy
| | - Raffaele Ratta
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Raimondi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Melanie Claps
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonia Martinetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Filippo G de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Vera Cappelletti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Verzoni
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Sponholz S, Schirren M, Oguzhan S, Mese M, Schirren J. Long-term Outcome After Resection of Isolated Thoracic Lymph Node Metastases of Renal Cell Cancer. Ann Thorac Surg 2019; 109:262-269. [PMID: 31499030 DOI: 10.1016/j.athoracsur.2019.07.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Isolated thoracic lymph node metastases (ITLNMs) without any lung metastases of renal cell cancer are rare. Other than a few case reports and one study, there is no further literature on ITLNMs. For this reason, the goal of this study was to analyze our experiences, the long-term survival outcomes, and recurrence-free survival outcomes after the resection of ITLNMs. METHODS We analyzed our database of 15 patients with ITLNMs who underwent metastasectomy by systematic lymph node dissection from 2003 to 2017. The long-term outcomes and survival curves were analyzed with the Kaplan-Meier method. RESULTS The median disease-free interval between primary cancer and ITLNM was 40 months (range, 0-171 months). The R0 resection rate was 93.3% (n = 14). There was one R2 resection, which was due to a tracheal and left main bronchial infiltration. The postoperative morbidity and 30-day mortality rates were 13.3% and 0%, respectively. Altogether, 14 patients were included in the long-term follow-up with a median follow-up time of 35.5 months (range, 2-108 months). The 1-, 3-, and 5-year survival rates were 93%, 73%, and 73%, respectively. The median overall progression-free survival after metastasectomy was 18 months (95% confidence interval, 8.6-27.4 months), and the 5-year local recurrence-free rate was 65%. CONCLUSIONS Because of the long disease-free interval between primary cancer and ITLNM, a long oncologic follow-up that includes chest images should be mandatory. Altogether, metastasectomy of ITLNMs is feasible with low morbidity and mortality rates and might be associated with promising survival rates. Early detection and resection of ITLNMs may avoid severe complications.
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Affiliation(s)
- Stefan Sponholz
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany.
| | - Moritz Schirren
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Selma Oguzhan
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Mesut Mese
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Joachim Schirren
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany
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Meyer AR, Carducci MA, Denmeade SR, Markowski MC, Pomper MG, Pierorazio PM, Allaf ME, Rowe SP, Gorin MA. Improved identification of patients with oligometastatic clear cell renal cell carcinoma with PSMA-targeted 18F-DCFPyL PET/CT. Ann Nucl Med 2019; 33:617-623. [PMID: 31147927 PMCID: PMC9774684 DOI: 10.1007/s12149-019-01371-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 05/21/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Complete surgical resection of metastatic sites has been shown to prolong survival in select patients with oligometastatic RCC. This treatment strategy is dependent upon the accurate characterization of a patient's extent of disease. The objective of this study was to explore the utility of PSMA-targeted 18F-DCFPyL PET/CT in patients with presumed oligometastatic clear cell RCC. METHODS This is a subset analysis of a prospective study in which patients with RCC were imaged with 18F-DCFPyL PET/CT (ClinicalTrials.gov identifier NCT02687139). In the present analysis, patients with oligometastatic clear cell RCC, defined as ≤ 3 metastatic lesions on conventional imaging, were evaluated. 18F-DCFPyL PET/CT scans were reviewed for sites of disease and compared to conventional imaging. RESULTS The final cohort included 14 patients with oligometastatic clear cell RCC. Conventional imaging revealed 21 metastatic lesions and 3 primary tumors. 18F-DCFPyL PET/CT detected 29 sites of metastatic disease and 3 primary tumors. Of the 21 metastatic lesions detected on conventional imaging, 17 (81.0%) had radiotracer uptake. Additionally, all 3 primary tumors had radiotracer uptake. In 4 (28.6%) patients a total of 12 more lesions were identified on 18F-DCFPyL PET/CT than conventional imaging. Notably, 3 (21.4%) patients were no longer considered oligometastatic. The detection rates of conventional imaging and 18F-DCFPyL PET/CT for identifying sites of disease were 66.7% and 88.9%, respectively. CONCLUSIONS PSMA-targeted PET/CT appears to aid in the identification of patients with oligometastatic clear cell RCC. If borne out in future studies, this suggests that PSMA-targeted imaging has the potential to help select candidates for metastasis-directed therapy.
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Affiliation(s)
- Alexa R. Meyer
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD 21287, USA
| | - Michael A. Carducci
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD 21287, USA,Department of Oncology, Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins University of Medicine, Baltimore, MD, USA
| | - Samuel R. Denmeade
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD 21287, USA,Department of Oncology, Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins University of Medicine, Baltimore, MD, USA
| | - Mark C. Markowski
- Department of Oncology, Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins University of Medicine, Baltimore, MD, USA
| | - Martin G. Pomper
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD 21287, USA,Department of Oncology, Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins University of Medicine, Baltimore, MD, USA,The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philip M. Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD 21287, USA,Department of Oncology, Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins University of Medicine, Baltimore, MD, USA
| | - Mohamad E. Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD 21287, USA,Department of Oncology, Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins University of Medicine, Baltimore, MD, USA
| | - Steven P. Rowe
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD 21287, USA,The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A. Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD 21287, USA,Department of Oncology, Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins University of Medicine, Baltimore, MD, USA,The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Apollonio G, Raimondi A, Verzoni E, Claps M, Sepe P, Pagani F, Ratta R, Montorsi F, De Braud FGM, Procopio G. The role of metastasectomy in advanced renal cell carcinoma. Expert Rev Anticancer Ther 2019; 19:603-611. [DOI: 10.1080/14737140.2019.1625772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Giulia Apollonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Raimondi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Verzoni
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Melanie Claps
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pierangela Sepe
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Pagani
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Raffaele Ratta
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Montorsi
- Urology Department, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | | | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Kim SH, Park WS, Park B, Pak S, Chung J. A Retrospective Analysis of the Impact of Metastasectomy on Prognostic Survival According to Metastatic Organs in Patients With Metastatic Renal Cell Carcinoma. Front Oncol 2019; 9:413. [PMID: 31179242 PMCID: PMC6538800 DOI: 10.3389/fonc.2019.00413] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022] Open
Abstract
This study evaluated the effects of metastasectomy on overall survival (OS) and progression-free survival (PFS) in metastatic renal cell carcinoma (mRCC) according to metastatic organs. The medical records (2005–2017) of 273 patients with mRCC were analyzed retrospectively to evaluate OS and PFS according to metastatic organs and their metastasectomy states. The Cox proportional hazard model was used to determine the prognostic significance of metastasectomy. The Kaplan-Meier curve and log-rank test were used to compare groups with different modalities and metastatic organs at a statistical significance of p < 0.05. The overall median age was 57 years; 175 (64.3%) and 83 (30.4%) patients received cytoreductive nephrectomy and metastasectomy, respectively. The metastasectomy group was significantly younger and had a lower clinical T stage with significantly better PFS/OS (20.2/32.0 vs. 9.7/12.8 months) than that in the non-metastasectomy group (N = 190, p < 0.05). Liver with lung metastases were the worst metastatic combination for survivals in which liver metastasis was the only significant unfavorable risk factor for both PFS (HR 1.67) and OS (HR 1.74) (p < 0.05). Multivariable analysis confirmed that metastasectomy was a significant favorable risk factor for PFS (HR 0.70) and OS (HR 0.56) (p < 0.05) along with non-clear cell type (HR 0.61 for PFS), whereas the nuclear grade and poor Heng risk group were unfavorable risk factors (HR > 2.0) for both PFS and OS (p < 0.05). Metastasectomy and the affected metastatic organs significantly influenced prognostic survival in mRCC.
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Affiliation(s)
- Sung Han Kim
- Department of Urology, Center for Urologic Cancer, Research Institute and Hospital of National Cancer Center, Goyang-si, South Korea
| | - Weon Seo Park
- Department of Pathology, Hospital of National Cancer Center, Center for Urologic Cancer, Goyang-si, South Korea
| | - Boram Park
- Biostatistics Collaboration Team, Research Core Center, Research Institute of National Cancer Center, Goyang-si, South Korea
| | - Sahyun Pak
- Department of Urology, Center for Urologic Cancer, Research Institute and Hospital of National Cancer Center, Goyang-si, South Korea
| | - Jinsoo Chung
- Department of Urology, Center for Urologic Cancer, Research Institute and Hospital of National Cancer Center, Goyang-si, South Korea
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Liang C, Takahashi K, Kurata M, Sakashita S, Oda T, Ohkohchi N. Recurrent renal cell carcinoma leading to a misdiagnosis of polycystic liver disease: A case report. World J Gastroenterol 2019; 25:2264-2270. [PMID: 31143076 PMCID: PMC6526153 DOI: 10.3748/wjg.v25.i18.2264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Polycystic liver disease (PCLD) with a large cystic volume deteriorates the quality of life of patients through substantial effects on the adjacent organs, recurrent cyst infections, cyst rupture, and hemorrhage. Surgical or radiological intervention is usually needed to alleviate these symptoms. We report a rare case of the cystic metastasis of renal cell carcinoma (RCC), which was misdiagnosed as PCLD, as a result of the clinical and radiological similarity between these disorders.
CASE SUMMARY A 74-year-old female who had undergone nephrectomy for papillary-type RCC (PRCC) was suffering from abdominal pain and the recurrent intracystic hemorrhage of multiple cysts in the liver. Imaging studies and aspiration cytology of the cysts showed no evidence of malignancy. With a diagnosis of autosomal dominant polycystic liver disease, the patient received hepatectomy for the purpose of mass reduction and infectious cyst removal. Surgery was performed without complications, and the patient was discharged on postoperative day 14. Postoperatively, the pathology revealed a diagnosis of recurrent PRCC with cystic formation.
CONCLUSION This case demonstrates the importance of excluding the cystic metastasis of a cancer when liver cysts are observed.
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Affiliation(s)
- Chen Liang
- Department of Surgery, University of Tsukuba, Tsukuba, Ibaraki Prefecture 3058575, Japan
| | - Kazuhiro Takahashi
- Department of Surgery, University of Tsukuba, Tsukuba, Ibaraki Prefecture 3058575, Japan
| | - Masanao Kurata
- Department of Surgery, University of Tsukuba, Tsukuba, Ibaraki Prefecture 3058575, Japan
| | - Shingo Sakashita
- Department of Diagnostic Pathology, University of Tsukuba, Tsukuba, Ibaraki Prefecture 3058575, Japan
| | - Tatsuya Oda
- Department of Surgery, University of Tsukuba, Tsukuba, Ibaraki Prefecture 3058575, Japan
| | - Nobuhiro Ohkohchi
- Department of Surgery, University of Tsukuba, Tsukuba, Ibaraki Prefecture 3058575, Japan
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Patel HV, Srivastava A, Shinder B, Sadimin E, Singer EA. Strengthening the foundation of kidney cancer treatment and research: revising the AJCC staging system. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S33. [PMID: 31032312 DOI: 10.21037/atm.2019.02.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Brian Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Evita Sadimin
- Section of Urologic Pathology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Zhuang Q, Shen J, Chen Z, Zhang M, Fan M, Xue D, Lu H, Xu R, He X, Hou J. MiR-337-3p suppresses the proliferation and metastasis of clear cell renal cell carcinoma cells via modulating Capn4. Cancer Biomark 2018; 23:515-525. [PMID: 30452399 DOI: 10.3233/cbm-181645] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Qianfeng Zhuang
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Jie Shen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Zhen Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Mingran Zhang
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Min Fan
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Dong Xue
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Hao Lu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Renfang Xu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiaozhou He
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Jianquan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Sec23a mediates miR-200c augmented oligometastatic to polymetastatic progression. EBioMedicine 2018; 37:47-55. [PMID: 30301603 PMCID: PMC6284370 DOI: 10.1016/j.ebiom.2018.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/12/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
Background Cancer treatment is based on tumor staging. Curative intent is only applied to localized tumors. Recent studies show that oligometastatic patients who have limited number of metastases may benefit from metastasis-directed local treatments to achieve long-term survival. However, mechanisms underlying oligometastatic to polymetastatic progression remains elusive. Methods The effects of miR-200c and Sec23a on tumor metastasis were verified both in vitro and in vivo. The secretome changes were detected by mass spectrometry. Findings We established a pair of homologous lung-metastasis derived oligometastatic and polymetastatic cell lines from human melanoma cancer cell line M14. Using the two cell lines, we have identified Sec23a, a gene target of miR-200c, suppresses miR-200c augmented oligometastatic to polymetastatic progression via its secretome. Firstly, miR-200c over-expression and Sec23a interference accelerated oligometastatic to polymetatic progression. Secondly, Sec23a functions downstream of miR-200c. Thirdly, mass spectrometric analysis of the secretory protein profile suggests that Sec23a-dependent secretome may impact metastatic colonization by modifying tumor microenvironment. Fourthly, the survival analysis using The Cancer Genome Atlas database shows Sec23a as a favorable prognostic marker for skin cutaneous melanoma, supporting the clinical relevance of our findings. Interpretation The finding that Sec23a is a suppressor of oligometastatic to polymetastatic progression has clinical implications. First, it provides a new theoretical framework for the development of treatments that prevent oligometastasis to polymetastasis. Second, Sec23a may be used as a favorable prognostic marker for the selection of patients with stable oligometastatic disease for oligometastasis-based local therapies of curative intent. Fund National Natural Science Foundations of China.
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