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Liu Y, Cheng W, Yang Q, Han Y, Jiang Q, Yang Y, Zhang H. Mining and validation of prognosis of various visceral metastasis in renal cell carcinoma: a study based on SEER database. Updates Surg 2024; 76:657-676. [PMID: 38165526 DOI: 10.1007/s13304-023-01703-4] [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: 08/04/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024]
Abstract
Our study was aimed to analyze a substantial of renal cell carcinoma (RCC) patients, research the high-risk factors and prognostic factors of metastasis, and thoroughly examine the effects of primary site surgery, lymph node dissection (LND), and chemotherapy on the prognosis of different visceral metastases. The baseline characteristics were characterized, and logistic regression was used to predict the risk factors for metastasis. Prognostic factors of metastatic RCC were assessed using batch univariate and multivariate Cox regression, with adjustments made through PSM. Next, the Kaplan-Meier method was employed to assess OS and create the survival curve. Logistic regression identified risk factors for metastasis: male gender [OR, 1.223; P < 0.001], Hist clear (OR, 9.37; P < 0.001), Hist papillary (OR, 2.49; P < 0.001), and TTX (OR, 23.33; P < 0.001). We found several independent prognostic variables: among which chemotherapy (HR, 0.64), local LND (HR, 0.67), and primary site surgery (HR, 0.97) were associated with better OS. Further study results demonstrated that all kinds of visceral metastasis except for liver metastasis in the operation group had substantially better prognoses than those in the non-operation group (P < 0.05). Regional LND had no discernible impact on survival. Patients with liver, lung, and distant lymph node (LN) metastasis benefited from chemotherapy (P < 0.05), but the bone and brain metastasis did not significantly benefit from treatment (P > 0.05). We recommend primary surgery for different types of visceral metastases except liver metastasis. Routine regional LND is not recommended. Chemotherapy should be considered for patients with lung, distant LN, and liver metastases, but not for those with bone and brain metastases.
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Affiliation(s)
- Yu Liu
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Wenjuan Cheng
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Qin Yang
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yucheng Han
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Qing Jiang
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yuanyuan Yang
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Haimin Zhang
- School of Medicine, Tongji University, Shanghai, 200092, China.
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China.
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The role of hepatic and pancreatic metastatectomy in the management of metastatic renal cell carcinoma: A systematic review. Surg Oncol 2022; 44:101819. [DOI: 10.1016/j.suronc.2022.101819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 12/09/2022]
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3
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Hopkins DT, Waters D, Manecksha RP, Lynch TH. Isolated soft tissue mass of the finger as the first presentation of oligometastatic renal cell carcinoma. BMJ Case Rep 2022; 15:e248718. [PMID: 35580945 PMCID: PMC9114857 DOI: 10.1136/bcr-2021-248718] [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] [Accepted: 05/03/2022] [Indexed: 11/04/2022] Open
Abstract
A man in his 70s was referred to plastic surgery with a suspected foreign body in the pulp of his right index finger. An excisional biopsy was performed for a presumed foreign body granuloma. Histology revealed metastatic renal cell carcinoma (mRCC). CT imaging demonstrated a 7.4 cm heterogeneous mass arising from the upper pole of the left kidney consistent with primary renal malignancy, in addition to a 9 mm lung nodule. He underwent an uncomplicated left laparoscopic cytoreductive nephrectomy and made a satisfactory recovery. To our knowledge, this is the first reported case of primary mRCC presenting with digital soft tissue metastasis. Cytoreductive nephrectomy with metastasectomy is the preferred management for mRCC where feasible. For unfavourable mRCC cases, first-line systemic therapy is indicated. Adjuvant systemic therapy in mRCC is currently limited to clinical trials, though promising data emerging on the use of pembrolizumab may herald a future shift in practice.
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Affiliation(s)
- David T Hopkins
- Department of Urology, Saint James's Hospital, Dublin, Ireland
- Department of Surgery, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Darragh Waters
- Department of Urology, Saint James's Hospital, Dublin, Ireland
| | - Rustom P Manecksha
- Department of Urology, Saint James's Hospital, Dublin, Ireland
- Department of Surgery, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Thomas H Lynch
- Department of Urology, Saint James's Hospital, Dublin, Ireland
- Department of Surgery, Trinity College Dublin School of Medicine, Dublin, Ireland
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Pinotti E, Montuori M, Giani A, Uggeri F, Garancini M, Gianotti L, Romano F. Surgical treatment of liver metastases from kidney cancer: a systematic review. ANZ J Surg 2019; 89:32-37. [PMID: 30685878 DOI: 10.1111/ans.15000] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/26/2018] [Accepted: 11/06/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver metastases are present in 20.3% of metastatic kidney cancers. The aim of this literature review was to assess the efficacy of surgical treatment for hepatic metastasis from kidney cancer. METHODS An extended web search of the literature was independently performed in March 2018 by two authors according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS Through electronic searches, we identified 935 potentially relevant citations. Thirteen articles were finally included in the systematic review. Median survival after resection ranged from 15 to 142 months while the 1-, 3- and 5-year overall survival ranged from 69% to 100%, 26% to 83.3% and 0% to 62%, respectively. Median disease-free survival ranged from 7.2 to 27 months. CONCLUSION Surgical treatment of hepatic metastases is performed in approximately 1% of patients with liver metastases and in select patients may be potentially curative. Surgical resection of liver metastases from kidney cancer represents a valid option for selected patients with metastatic renal cancer.
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Affiliation(s)
- Enrico Pinotti
- Department of Surgery, University of Milano Bicocca, School of Medicine and Surgery, San Gerardo Hospital, Monza, Italy
| | - Mauro Montuori
- Department of Surgery, University of Milano Bicocca, School of Medicine and Surgery, San Gerardo Hospital, Monza, Italy
| | - Alessandro Giani
- Department of Surgery, University of Milano Bicocca, School of Medicine and Surgery, San Gerardo Hospital, Monza, Italy
| | - Fabio Uggeri
- Department of Surgery, University of Milano Bicocca, School of Medicine and Surgery, San Gerardo Hospital, Monza, Italy
| | - Mattia Garancini
- Department of Surgery, University of Milano Bicocca, School of Medicine and Surgery, San Gerardo Hospital, Monza, Italy
| | - Luca Gianotti
- Department of Surgery, University of Milano Bicocca, School of Medicine and Surgery, San Gerardo Hospital, Monza, Italy
| | - Fabrizio Romano
- Department of Surgery, University of Milano Bicocca, School of Medicine and Surgery, San Gerardo Hospital, Monza, Italy
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Abstract
The role of surgery for RCC in the era of emerging effective systemic therapy (usually immunotherapy) is not yet defined except for solitary metastasis. The retrospective analysis of patients subjected to aggressive surgical management after systemic therapy reinforces the need to find better therapeutic modalities in order to achieve complete eradication of metastatic disease. In the meantime, however, we propose these guidelines. First, we would encourage aggressive surgical resection of the clinically solitary metastasis, whether synchronous or metachronous. Continue to follow those patients indefinitely, because relapse is quite likely, but do not give adjuvant systemic therapy unless on protocol. Second, limited metastases in only one organ may behave similarly to a solitary metastasis, and if the metastases are in a site amenable to surgical resection, e.g., lung, initial surgery might be reasonable. Systemic therapy for these patients is highly recommended and need not necessarily wait for recurrence. Third, for patients with multiple metastases, initial systemic therapy followed then by resection of any residual disease in selected patients seems to be supported by the experience at several medical centers. Apparently prolonged survival times have been observed after systemic therapy followed by surgery in highly selected patients, despite finding viable cancer in the overwhelming majority of specimens. One must be mindful of the morbidity of an attempt to remove all known disease, however, and try to weigh this against potential benefit. Only a prospective, randomized trial could ever confirm the value of an aggressive surgical approach to metastatic RCC. In the meantime, however, metastasectomy offers, at the very least, the opportunity to confirm the histologic response to systemic therapy, render some patients disease-free, and possibly promote long-term survival in selected patients.
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Affiliation(s)
- D A Swanson
- Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Pikoulis E, Margonis GA, Antoniou E. Surgical Management of Renal Cell Cancer Liver Metastases. Scand J Surg 2016; 105:263-268. [PMID: 26929295 DOI: 10.1177/1457496916630644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS There is an increasing trend toward performing liver resections in the setting of metastatic disease. Renal cell cancer liver metastases are associated with poor survival. The indications for and the short- and long-term outcomes of liver resection for renal cell cancer liver metastases remain not well defined. MATERIAL AND METHODS A focused, structured literature review on PubMed, EMBASE, and Google Scholar was performed to identify primary research articles, on short- and long-term outcomes and prognostic factors of patients undergoing liver resection for renal cell cancer liver metastases. Only studies with a sample size equal or larger than 10 patients were included. RESULTS AND CONCLUSION A total of 10 studies met inclusion criteria. Median overall survival ranged between 16 and 142 months. Major morbidity was rare while 30-day postoperative mortality was less than 5%. A disease-free interval of more than 2 years from nephrectomy to evidence of liver metastases and a radical, microscopically negative surgical resection (R0) were the most consistent prognostic factors that, in turn, could be used as potential selection criteria to identify patients who can benefit the most from liver-directed surgery. Liver surgery for renal cell cancer liver metastases can be performed with low mortality, acceptable morbidity, and promising survival benefit in carefully selected patients. Studies that can assess the impact of modern, targeted regimens in the preoperative setting and liver-directed surgery and in turn shape new selection criteria are warranted.
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Affiliation(s)
- E Pikoulis
- 1 First Department of Surgery, Laiko Hospital, University of Athens, Athens, Greece
| | - G A Margonis
- 2 Department of Surgery, Johns Hopkins University, Baltimore, USA
| | - E Antoniou
- 3 Second Department of Propaedeutic Surgery, Laiko Hospital, University of Athens, Athens, Greece
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Bex A. Integrating metastasectomy and stereotactic radiosurgery in the treatment of metastatic renal cell carcinoma. EJC Suppl 2015. [PMID: 26217128 PMCID: PMC4041303 DOI: 10.1016/j.ejcsup.2013.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Axel Bex
- The Netherlands Cancer Institute, Department of Urology, Amsterdam, The Netherlands
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Husillos Alonso A, Carbonero García M, González Enguita C. Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma? World J Nephrol 2015; 4:254-262. [PMID: 25949939 PMCID: PMC4419135 DOI: 10.5527/wjn.v4.i2.254] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/18/2015] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Metastatic renal cell carcinoma (mRCC) is a challenging disease. Despite the new targeted therapies, complete remissions occur only in 1%-3% of the cases, and the most effective first-line treatment drugs have reached a ceiling in overall survival (ranging from 9 to 49 mo). Metastasectomy remains to be the only curative option in most patients with mRCC. Prognostic nomograms have been recently published, so we have tools to classify patients in risk groups, allowing us to detect the cases with the higher risk of recurrence after metastasectomy. Although sparse, there is some evidence of effectiveness of neoadjuvant targeted therapy before metastasectomy; but with an increase in surgical complications due to the effects of these new drugs in tissue healing. We have aimed to answer the question: Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma? We have made a search in Pubmed database. As far as we know, evidence is low and it’s based in case reports and small series of patients treated with adjuvant drugs after neoadjuvant therapy plus metastasectomy in cases of partial response to initial systemic treatment. Despite the limitations and high risk of bias, promising results and cases with long-term survival with this approach have been described. Two ongoing clinical trials may answer the question that concerns us.
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Dabestani S, Bex A. Metastasectomy. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Fitzgerald TL, Brinkley J, Banks S, Vohra N, Englert ZP, Zervos EE. The benefits of liver resection for non-colorectal, non-neuroendocrine liver metastases: a systematic review. Langenbecks Arch Surg 2014; 399:989-1000. [PMID: 25148767 DOI: 10.1007/s00423-014-1241-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/11/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Defining the benefits of resection of isolated non-colorectal, non-neuroendocrine (NCRNNE) liver metastases is difficult. To better understand the survival benefit in this group of patients, we conducted a systematic review of the previous literature. METHODS Medline, Web of Knowledge, and manual searches were performed using search terms, such as "liver resection" and "primary tumor." Inclusion criteria were year>1990, >five patients, and median survival reported or derived. An expected median survival was calculated from weighted averages of median survivals, and differences were assessed using a permutation test. RESULTS A total of 7,857 references were identified. Overall 4,735 abstracts were reviewed; 120 manuscripts evaluated and of these, 73 met the study inclusion criteria. The final population consisted of 3,596 patients with renal (n=234), ovarian (n=119), testicular (n=153), adrenal (n=90), small bowel (n=28), gallbladder (n=21), duodenum (n=38), gastric (n=481), pancreatic (n=55), esophageal (n=23), head and neck (n=15), and lung (n=36) cancers, gastrointestinal stromal tumors (GISTs) (n=106), cholangiocarcinoma (n=13), sarcoma (n=189), and melanoma (n=643). The greatest expected median was 63 months for genitourinary (GU) primaries (n=549; range 5.4-142 months) followed by 44.4 months for breast cancer (n=1,013; range 8-74 months), 22.3 months for gastrointestinal cancer (n=549; range 5-58 months), and 23.7 months for other tumor types (n=1,082; range 10-72 months). Using a permutation test, we observed that survival was best for patients with GU primaries followed by that for breast cancer patients. Additionally, we also observed that survival was similar for those with cancer of the GI tract and other primary sites. CONCLUSIONS There appears to be a benefit to resection for patients with NCRNNE liver metastases. The degree of survival advantage is predicated by primary site.
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Affiliation(s)
- Timothy L Fitzgerald
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine, East Carolina University, 4S24 600 Moye Boulevard, Greenville, NC, 27834, USA,
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11
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Breda A, Konijeti R, Lam JS. Patterns of recurrence and surveillance strategies for renal cell carcinoma following surgical resection. Expert Rev Anticancer Ther 2014; 7:847-62. [PMID: 17555395 DOI: 10.1586/14737140.7.6.847] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Renal cell carcinoma (RCC) remains one of the most lethal urologic malignancies, with up to 40% of patients eventually dying of cancer progression. Despite advances in the diagnosis, staging and treatment of patients with RCC, approximately a third of patients who undergo surgery for clinically localized RCC will suffer a recurrence. Timely identification of recurrences following surgical extirpation is imperative in the treatment of these patients. RCC is known to metastasize through hematogenous routes of spread to distant organ sites and via lymphatic channels to regional lymph nodes. The path of tumor escape is associated with diverse clinical outcomes and a unique tumor biology. A consensus on surveillance regimens for patients following surgical resection of localized disease is lacking. The most extensively used system for providing prognostic information regarding survival and recurrence of disease has historically been the tumor-node-metastasis (TNM) classification system. As a result, most contemporary surveillance protocols have tailored follow-up regimens according to stage-based stratifications. Numerous studies have recently demonstrated that certain clinical and histopathological factors can improve the prediction of tumor recurrence. The incorporation of these prognostic factors into stage-based stratification models should be better than stage alone in attempting to provide a rational approach to identifying treatable recurrences while minimizing unnecessary exams and tests, as well as patient anxiety. Advances in the understanding of the pathogenesis, behavior and molecular biology of RCC have paved the way for developments that may enhance early diagnosis and prognostication, and improve survival for patients. Lastly, molecular markers should, in the future, revolutionize surveillance protocols for RCC by tailoring follow-up to specific molecular classifications.
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Affiliation(s)
- Alberto Breda
- David Geffen School of Medicine, University of California--Los Angeles, Department of Urology, Los Angeles, CA 90095-1738, USA.
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12
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Mitomo S, Takahara T, Nitta H, Fujita T, Ito N, Uesugi N, Sugai T, Wakabayashi G. Sunitinib treatment enabling resection of massive liver metastasis: a case report. J Med Case Rep 2013; 7:234. [PMID: 24090151 PMCID: PMC3874753 DOI: 10.1186/1752-1947-7-234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/12/2013] [Indexed: 11/13/2022] Open
Abstract
Introduction Sunitinib was developed as a molecular-targeted drug to treat advanced renal cell carcinoma. It is not yet known whether liver damage occurs in patients with liver metastases of renal cell carcinoma after sunitinib administration. Here, we report the case of a patient with an inoperable massive liver metastasis of renal cell carcinoma for whom sunitinib administration was dramatically effective with no obvious evidence of liver damage. As a result, the liver metastasis could be resected. We emphasize the dramatic reduction in liver metastasis with sunitinib treatment, and the histopathological effects of sunitinib on the non-tumorous liver parenchyma. Case presentation A 54-year-old Japanese woman was diagnosed with right renal cell carcinoma and underwent right nephrectomy 12 years earlier. She presented to a local clinic with right abdominal pain. A computed tomography scan showed a massive liver metastasis occupying her right hepatic lobe, and she was referred to our hospital for treatment. The diagnosis was not only liver metastasis, but also left renal metastasis. Oral administration of tyrosine kinase inhibitor sunitinib was started. Adverse events due to sunitinib included liver dysfunction, thrombocytopenia, and decreased hemoglobin, but she completed eight courses with the help of drug holidays and dose adjustments. Post-treatment computed tomography showed a dramatic reduction in size of her liver metastasis, enabling right lobectomy of her liver. Histopathological findings showed no obvious liver damage due to chemotherapy in non-cancerous parenchymal areas. Conclusions With the availability of sunitinib, some patients with potentially unresectable massive liver metastases of renal cell carcinoma may be able to undergo major hepatectomy curatively and safely with little histopathological damage to non-tumorous liver parenchyma, thus improving their prognosis.
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Affiliation(s)
- Shingo Mitomo
- Department of Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan.
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Bex A. Metastasectomy. KIDNEY CANCER 2012. [DOI: 10.1007/978-3-642-21858-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kramer MW, Merseburger AS, Peters I, Waalkes S, Kuczyk MA. [Systemic and surgical management of metastatic renal cell carcinoma]. Urologe A 2011; 51:217-25. [PMID: 22009257 DOI: 10.1007/s00120-011-2713-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Several targeted therapies have become available for first-line (sunitinib, bevacizumab, pazopanib, temsirolimus) and second-line (sorafenib, pazopanib, everolimus) use in recent years. The superior outcomes achieved with these targeted agents have led to replacement of the formerly administered cytokines. New developments have raised the question of whether patients benefit from sequential therapies with tyrosine kinase inhibitors and/or whether combination regimes can improve clinical outcomes. This review gives an overview of the current therapeutic options for first- and second-line treatment in metastatic RCC as well as sequential and combination therapies. Adjuvant and neoadjuvant treatment options are being discussed. Furthermore, this review addresses surgical alternatives in the treatment of RCC.
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Affiliation(s)
- M W Kramer
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, Deutschland
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Liver resection for metastatic disease prolongs survival in renal cell carcinoma: 12-year results from a retrospective comparative analysis. World J Urol 2010; 28:543-7. [PMID: 20440505 DOI: 10.1007/s00345-010-0560-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 04/14/2010] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED The value of surgical resection of renal cell carcinoma (RCC) liver metastases still remains unclear. OBJECTIVE Of our study was to evaluate the efficacy of liver resection by comparing patients who could have undergone metastasectomy due to limited disease, but refused surgery. MATERIALS AND METHODS Eighty-eight patients were identified with liver metastases and indication of surgery between 1995 and 2006. In 68 patients, liver resection was performed, 20 patients denied surgery and served as comparison group. Patients were followed for survival. RESULTS Median age was 58. Median amount of liver metastases was 2 (range 1-30). Median follow-up was 26 months (range 1-187). In both groups, 79% received systemic therapy. The 5-year overall survival rate (OSR-5) after metastasectomy was 62.2% +/- 11.4% (SEM) with a median survival (MS) of 142 (95% confidence interval (CI) 115-169) months. OSR-5 in the control group was 29.3% +/- 22.0% (SEM) with a MS of 27 (95% CI 16-38) months (P = 0.003). MS was 155 (95% CI 133-175) months with metachronous metastases compared to 29 (95% CI 25-33) months in the comparison group (P = 0.001). Low-grade primary RCC had a MS of 155 (95% CI 123-187) months compared to 29 (95% CI 8-50) months without resection (P = 0.0036). High-grade RCC as well as patients with synchronous metastases did not benefit from surgery. CONCLUSIONS Liver metastasectomy is an independent valuable tool in the treatment of metastatic RCC and significantly prolongs patient's survival, even if further systemic treatment is necessary. With the evidence given, patients may benefit from liver metastasis resection if technically feasible.
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17
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Chiche L, Adam R. [Role and technical aspects of surgery for liver metastases from urological malignancies]. Prog Urol 2008; 18 Suppl 7:S256-60. [PMID: 19070802 DOI: 10.1016/s1166-7087(08)74553-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The liver is the third localisation of metastatic urological tumours after the bone and the lungs. Most frequently, it occurs as a multimetastatic disease for which surgery is not feasible. Nevertheless, when the metastasis is unique and when resection can be complete, it can be proposed if the localisation and the global prognosis permit. Recent therapeutic progress, including new improved drugs, progress in surgical procedures and the multisciplinary approach, lead to propose tumorectomy or hepatectomy for a few selected patients with hepatic metastasis from urological tumours.
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Affiliation(s)
- L Chiche
- CHU Caen, Département de Chirurgie digestive, France.
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Solitary Liver Metastasis of Chromophobe Renal Cell Carcinoma 20 Years After Nephrectomy Treated by Hepatic Resection. Urology 2008; 72:230.e5-6. [DOI: 10.1016/j.urology.2007.11.134] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 11/14/2007] [Accepted: 11/27/2007] [Indexed: 11/23/2022]
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Goéré D, Elias D. Resection of liver metastases from non-colorectal non-endocrine primary tumours. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2007; 34:281-8. [PMID: 17933487 DOI: 10.1016/j.ejso.2007.07.205] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 07/20/2007] [Indexed: 10/22/2022]
Abstract
Despite the greater number of hepatectomies for non-colorectal non-endocrine liver metastases, its benefits and its indications remain unclear because most of the patient series are small with heterogeneous primary tumours. After analyzing the literature including a large recent series (1451 patients), we can conclude that liver resection of non-colorectal non-endocrine metastases is feasible, safe, and improves survival. Better selection of patients according to their tumour biology (a long interval between the primary and liver metastases), the histologic type (non epithelial) and tumour chemosensitivity should improve long-term disease-free and overall survival, as we observed after resection of liver metastases from colorectal cancer.
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Affiliation(s)
- D Goéré
- Department of Surgical Oncology, Institut Gustave Roussy, 39 Rue Camille Desmoulins, 94805 Villejuif Cedex, France.
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Thelen A, Jonas S, Benckert C, Lopez-Hänninen E, Rudolph B, Neumann U, Neuhaus P. Liver resection for metastases from renal cell carcinoma. World J Surg 2007; 31:802-7. [PMID: 17354021 DOI: 10.1007/s00268-007-0685-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study was conducted to evaluate the safety and efficacy of liver resection in patients with hepatic metastases from renal cell carcinoma and to identify selection criteria for patients suitable for resection. METHODS Between January 1988 and March 2006, 31 patients underwent liver resection for metastases from renal cell carcinoma. Patients were identified from a prospective database and retrospectively reviewed. Patient, tumor, and operative parameters were analyzed for their influence on long-term survival. RESULTS The overall 1-, 3- and 5-year survival rates were 82.2%, 54.3%, and 38.9%, respectively. One patient was deceased and 4 developed complications during the postoperative course. In the univariate analysis, site of the primary tumor (P = 0.013), disease-free interval (P = 0.012), and resection margins (P = 0.008) showed significant influence on long-term survival. In the multivariate analysis, only the resection margins were identified as an independent prognostic factor after liver resection. CONCLUSIONS Liver resection is effective and safe in the treatment of patients with hepatic metastases from renal cell carcinoma and offers the chance of long-term survival and cure. Achieving a margin-negative resection is the most important criterion in the selection of suitable patients for liver resection. However, the number of patients in the present study was small, and investigations of larger series may provide further prognostic parameters in these patients.
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Affiliation(s)
- Armin Thelen
- Departmant of General, Visceral and Transplantation Surgery, Campus Virchow-Klinikum, Charité Universitaetsmedizin Berlin, Berlin, Germany.
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Quicios Dorado C, Mayayo Dehesa T, Nuño Vázquez-Gaza J, García Teruel D, López Buenadicha A, Díez Nicolás V. Tumor renal con invasión hepática: aportación de un nuevo caso y revisión de la literatura. Actas Urol Esp 2007; 31:541-7. [PMID: 17711174 DOI: 10.1016/s0210-4806(07)73679-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Locally advanced renal cell carcinoma (RCC) with involvement to adjacent organs is uncommon and the prognosis is poor. Radical surgery remains the only effective treatment. We report the case of a woman with RCC and direct liver extension who was surgically treated. A literature review is made.
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Rasco DW, Assikis V, Marshall F. Integrating Metastasectomy in the Management of Advanced Urological Malignancies—Where are we in 2005? J Urol 2006; 176:1921-6. [PMID: 17070212 DOI: 10.1016/j.juro.2006.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE In the past patients with metastatic cancer were considered incurable and they were not candidates for surgical management of metastases. However, experience with testicular cancer has shown that metastasectomy can often be the final, critical step in achieving disease-free status. We summarized the most current data on metastasectomy for advanced urological malignancies. MATERIALS AND METHODS We performed an extensive review of the literature from 1990 to the present using MEDLINE. Only original reports were included with an emphasis on specific malignancies and specific sites of metastasis. RESULTS There is increasing evidence that patients with metastatic renal cell carcinoma and bladder carcinoma can be cured by surgical resection of metastases, usually combined with systemic therapy. The ideal patient has responded to systemic therapy and has few metastatic sites. CONCLUSIONS Metastasectomy should frequently be done in patients with advanced testicular cancer and it should increasingly be considered in patients with metastatic renal cell carcinoma or bladder carcinoma. This technique may be used for cure and palliation. Specific patient factors determine the likelihood and degree of potential benefit.
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Affiliation(s)
- Drew W Rasco
- Medicine Department, Emory University Medical School, Atlanta, Georgia 30322, USA
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Bradford TJ, Montie JE, Hafez KS. The Role of Imaging in the Surveillance of Urologic Malignancies. Urol Clin North Am 2006; 33:377-96. [PMID: 16829272 DOI: 10.1016/j.ucl.2006.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urologic malignancies are common, accounting for approximately 25% of all new cancer cases in the United States. Patients with urologic malignancies require long-term surveillance to detect progression or recurrence as early as possible. The urologist is faced with the task of balancing patient safety and cost-effectiveness, while finding the most practical follow-up regimen. For each urologic malignancy, this article reviews the commonly used radiologic techniques for surveillance and offers recommended follow-up schedules.
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Affiliation(s)
- Timothy J Bradford
- Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA
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24
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Aloia TA, Adam R, Azoulay D, Bismuth H, Castaing D. Outcome following hepatic resection of metastatic renal tumors: the Paul Brousse Hospital experience. HPB (Oxford) 2006; 8:100-5. [PMID: 18333255 PMCID: PMC2131423 DOI: 10.1080/13651820500496266] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND As many as 50% of patients with renal cell carcinoma (RCC) will develop systemic metastases. When hepatic metastases from RCC present in a resectable distribution, our group and other groups have previously shown that some patients benefit from curative hepatic resection. In this report we update our own experience and summarize the literature published to date on this topic. PATIENTS AND METHODS From 1982 to 2005, 19 patients (9 men, 10 women, median age 50 years) with hepatic metastases from RCC were treated with hepatic resection at our institution. In 14 (74%) of the 19 patients the presentation of hepatic metastases was metachronous. Seven (37%) patients had been or were simultaneously treated for extrahepatic metastases. The mean tumor number was 2 and the mean diameter of the largest metastasis was 73 mm. RESULTS Margin-negative resection was achieved in 17 (89%) of 19 cases. Postoperative morbidity and mortality rates were 32% and 5%, respectively. At a median follow-up interval of 26 months, 15 patients recurred with a mean time to recurrence of 12 months. The 3-year and 5-year disease-free survival rates were 25% and 25%, respectively; 3-year and 5-year overall survival rates were 52% and 26%, respectively, with one patient alive 5 years following first hepatectomy. Study factors which predicted prolonged survivals included male sex and maximum tumor diameter </=5 cm. DISCUSSION The overall survival rates in our series (3-year, 52%; 5-year, 26%) and in a complete review of the literature (3-year, 24%; 5-year, 18%) indicate that selected patients with hepatic metastases from RCC benefit from hepatic resection.
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Affiliation(s)
- Thomas A. Aloia
- Department of Surgery, Centre Hépato-Biliare, L'hôpital Paul BrousseVillejuifFrance
| | - René Adam
- Department of Surgery, Centre Hépato-Biliare, L'hôpital Paul BrousseVillejuifFrance
| | - Daniel Azoulay
- Department of Surgery, Centre Hépato-Biliare, L'hôpital Paul BrousseVillejuifFrance
| | - Henri Bismuth
- Department of Surgery, Centre Hépato-Biliare, L'hôpital Paul BrousseVillejuifFrance
| | - Denis Castaing
- Department of Surgery, Centre Hépato-Biliare, L'hôpital Paul BrousseVillejuifFrance
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Alves A, Adam R, Majno P, Delvart V, Azoulay D, Castaing D, Bismuth H. Hepatic resection for metastatic renal tumors: is it worthwhile? Ann Surg Oncol 2003; 10:705-10. [PMID: 12839857 DOI: 10.1245/aso.2003.07.024] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Liver metastases of malignant renal tumors are regarded as having an ominous prognosis because they are infrequently amenable to radical surgery and respond poorly to chemotherapy. Little is known of the outcome of isolated metastases to the liver for which resection is potentially curative. METHODS Data on 14 patients with liver metastases from renal tumors who underwent a liver resection in a single center between 1982 and 2001 were analyzed retrospectively. RESULTS There was no operative or postoperative mortality. The median survival was 26 months, with a survival rate of 69% at 1 year and 26% at 3 years. The curative pattern of hepatectomy (2-year survival, 69% vs. 0%; P =.001), an interval between the nephrectomy and the diagnosis of liver metastases in excess of 24 months (2-year survival, 71% vs. 25%; P =.05), tumor size <50 mm (2-year survival, 83% vs. 17%; P =.006), and the possibility of achieving a repeat hepatectomy in the case of recurrence (2-year survival, 100% vs. 21%; P =.02) were associated with a better outcome after the liver resection. Four patients were alive without evidence of disease at 6, 12, 26, and 96 months after the first hepatic resection, and one was alive with hepatic recurrence 18 months after resection. CONCLUSIONS In patients with liver metastases of malignant renal tumors, an aggressive policy for achieving tumor eradication seems to offer a chance for long-term survival, especially after a long disease-free interval from the nephrectomy. However, despite an aggressive policy for achieving tumor eradication, recurrence frequently occurs after liver resection.
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Affiliation(s)
- A Alves
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris-Sud, Villejuif, France
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26
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Büchler P, Pfannschmidt J, Rudek B, Dienemann H, Lehnert T. Surgical treatment of hepatic and pulmonary metastases from non-colorectal and non-neuroendocrine carcinoma. Scand J Surg 2003; 91:147-54. [PMID: 12164514 DOI: 10.1177/145749690209100203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical resection is standard treatment for colorectal and neuroendocrine liver metases provided the tumor can be removed completely. The same is true for isolated pulmonary metastases. To date, only few reports have addressed the value of surgical resection of organ metastases from other solid tumors. METHODS The literature was searched by Medline, conference proceedings and cross-referencing of published articles for information pertaining to the long-term results of surgical treatment of non-colorectal and non-neuroendocrine (NCNN) liver or lung metastases. RESULTS Resection of hepatic and pulmonary metastases is increasingly performed in non-colorectal and non-neuroendocrine malignancies. Mortality and morbidity of hepatic and pulmonary resection are low and 5 year survival can be expected to reach some 20-30 percent, irrespective of the histological type of the primary tumor. CONCLUSION Resection of hepatic or pulmonary metastasis should be considered in all patients with low operative risk provided that complete resection is possible.
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Affiliation(s)
- P Büchler
- Department of Surgery, University of Heidelberg, FRG
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27
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van Ruth S, Mutsaerts E, Zoetmulder FA, van Coevorden F. Metastasectomy for liver metastases of non-colorectal primaries. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2001; 27:662-7. [PMID: 11669595 DOI: 10.1053/ejso.2001.1210] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Resection of liver metastases of non-colorectal primary malignancies has been reported to prolong survival. We studied the results in our hospital and compared the survival data with that described in the literature. PATIENTS AND METHODS Since 1991, a prospective database has been kept at The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital of patients undergoing hepatic surgery (n=180). Between 1991 and 1999, 32 patients underwent laparotomy for hepatic metastases of non-colorectal primaries. This study evaluates the operative technical aspects and determines morbidity, mortality, disease-free and overall survival. RESULTS There were 11 males and 21 females with a median age of 52 (25-69) years. Histology of the primary tumour were various carcinomas (n=22), melanomas (n=4) and sarcomas (n=6). Resection was performed in 28 patients; four patients appeared to be irresectable. There was no perioperative mortality. Morbidity was 23%. One re-operation was necessary because of haemorrhage. The median disease-free survival for the 28 patients was 12 months with an actuarial 5-year disease-free survival of 20% (Kaplan-Meier). The 5-year overall survival was 35% with a median survival of 21 months. CONCLUSION Liver metastasectomy for selected types of non-colorectal primary tumours is relatively safe and shows in selected patients long-term survival comparable to that of metastasectomies for colorectal origin.
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Affiliation(s)
- S van Ruth
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Hemming AW, Cattral MS. Ex vivo liver resection with replacement of the inferior vena cava and hepatic vein replacement by transposition of the portal vein. J Am Coll Surg 1999; 189:523-6. [PMID: 10549741 DOI: 10.1016/s1072-7515(99)00192-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A W Hemming
- Department of Surgery, University of Toronto, Ontario, Canada
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Abstract
Curative surgery in more advanced renal cell carcinoma is limited to solitary metastases or regional disease. Response to systemic immunotherapy continues to be reported; however, most responses are limited and not durable. Only randomized, prospective clinical trials will prove the efficacy of systemic therapy.
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Affiliation(s)
- D Y Chan
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA
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