Impact of Synchronous Metastasis Distribution on Cancer Specific Survival in Renal Cell Carcinoma after Radical Nephrectomy with Tumor Thrombectomy

No AccessJournal of UrologyAdult Urology1 Feb 2015Impact of Synchronous Metastasis Distribution on Cancer Specific Survival in Renal Cell Carcinoma after Radical Nephrectomy with Tumor Thrombectomy Derya Tilki, Brian Hu, Hao G. Nguyen, Marc A. Dall'Era, Roberto Bertini, Joaquín A. Carballido, Thenappan Chandrasekar, Thomas Chromecki, Gaetano Ciancio, Siamak Daneshmand, Paolo Gontero, Javier Gonzalez, Axel Haferkamp, Markus Hohenfellner, William C. Huang, Theresa M. Koppie, Estefania Linares, C. Adam Lorentz, Philipp Mandel, Juan I. Martinez-Salamanca, Viraj A. Master, Rayan Matloob, James M. McKiernan, Carrie M. Mlynarczyk, Francesco Montorsi, Giacomo Novara, Sascha Pahernik, Juan Palou, Raj S. Pruthi, Krishna Ramaswamy, Oscar Rodriguez Faba, Paul Russo, Shahrokh F. Shariat, Martin Spahn, Carlo Terrone, William Thieu, Daniel Vergho, Eric M. Wallen, Evanguelos Xylinas, Richard Zigeuner, John A. Libertino, and Christopher P. Evans Derya TilkiDerya Tilki Department of Urology, University of California, Davis School of Medicine, Sacramento, California , Brian HuBrian Hu Department of Urology, University of California, Davis School of Medicine, Sacramento, California USC/Norris Comprehensive Cancer Center, Los Angeles, California , Hao G. NguyenHao G. Nguyen Department of Urology, University of California, Davis School of Medicine, Sacramento, California , Marc A. Dall'EraMarc A. Dall'Era Department of Urology, University of California, Davis School of Medicine, Sacramento, California , Roberto BertiniRoberto Bertini Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy , Joaquín A. CarballidoJoaquín A. Carballido Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain , Thenappan ChandrasekarThenappan Chandrasekar Department of Urology, University of California, Davis School of Medicine, Sacramento, California , Thomas ChromeckiThomas Chromecki Department of Urology, Medical University of Graz, Graz, Austria , Gaetano CiancioGaetano Ciancio Miami Transplant Institute, University of Miami, Miami, Florida , Siamak DaneshmandSiamak Daneshmand USC/Norris Comprehensive Cancer Center, Los Angeles, California , Paolo GonteroPaolo Gontero Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy , Javier GonzalezJavier Gonzalez Department of Urology, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain , Axel HaferkampAxel Haferkamp Department of Urology, University of Frankfurt, Frankfurt, Germany , Markus HohenfellnerMarkus Hohenfellner Department of Urology, University of Heidelberg, Heidelberg, Germany , William C. HuangWilliam C. Huang Department of Urology, New York University School of Medicine, New York, New York , Theresa M. KoppieTheresa M. Koppie Department of Urology, Oregon Health & Science University, Portland, Oregon , Estefania LinaresEstefania Linares Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain , C. Adam LorentzC. Adam Lorentz Department of Urology, Emory University, Atlanta, Georgia , Philipp MandelPhilipp Mandel Institute of Empirical Economic Research, University of Leipzig, Leipzig, Germany , Juan I. Martinez-SalamancaJuan I. Martinez-Salamanca Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain , Viraj A. MasterViraj A. Master Department of Urology, Emory University, Atlanta, Georgia , Rayan MatloobRayan Matloob Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy , James M. McKiernanJames M. McKiernan Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York , Carrie M. MlynarczykCarrie M. Mlynarczyk Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York , Francesco MontorsiFrancesco Montorsi Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy , Giacomo NovaraGiacomo Novara University of Padua, Padua, Italy , Sascha PahernikSascha Pahernik Department of Urology, University of Heidelberg, Heidelberg, Germany , Juan PalouJuan Palou Department of Urology, Fundació Puigvert, Barcelona, Spain , Raj S. PruthiRaj S. Pruthi Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina , Krishna RamaswamyKrishna Ramaswamy Department of Urology, New York University School of Medicine, New York, New York , Oscar Rodriguez FabaOscar Rodriguez Faba Department of Urology, Fundació Puigvert, Barcelona, Spain , Paul RussoPaul Russo Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York , Shahrokh F. ShariatShahrokh F. Shariat Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria , Martin SpahnMartin Spahn University of Würzburg, Würzburg, Germany , Carlo TerroneCarlo Terrone Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy , William ThieuWilliam Thieu Department of Urology, University of California, Davis School of Medicine, Sacramento, California , Daniel VerghoDaniel Vergho University of Würzburg, Würzburg, Germany , Eric M. WallenEric M. Wallen Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina , Evanguelos XylinasEvanguelos Xylinas Department of Urology, Weill Cornell Medical Center, New York, New York , Richard ZigeunerRichard Zigeuner Department of Urology, Medical University of Graz, Graz, Austria , John A. LibertinoJohn A. Libertino Department of Urology, Lahey Clinic, Burlington, Massachusetts , and Christopher P. EvansChristopher P. Evans Department of Urology, University of California, Davis School of Medicine, Sacramento, California View All Author Informationhttps://doi.org/10.1016/j.juro.2014.07.087AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Metastatic renal cell carcinoma can be clinically diverse in terms of the pattern of metastatic disease and response to treatment. We studied the impact of metastasis and location on cancer specific survival. Materials and Methods: The records of 2,017 patients with renal cell cancer and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1971 to 2012 at 22 centers in the United States and Europe were analyzed. Number and location of synchronous metastases were compared with respect to patient cancer specific survival. Multivariable Cox regression models were used to quantify the impact of covariates. Results: Lymph node metastasis (155) or distant metastasis (725) was present in 880 (44%) patients. Of the patients with distant disease 385 (53%) had an isolated metastasis. The 5-year cancer specific survival was 51.3% (95% CI 48.6–53.9) for the entire group. On univariable analysis patients with isolated lymph node metastasis had a significantly worse cancer specific survival than those with a solitary distant metastasis. The location of distant metastasis did not have any significant effect on cancer specific survival. On multivariable analysis the presence of lymph node metastasis, isolated distant metastasis and multiple distant metastases were independently associated with cancer specific survival. Moreover higher tumor thrombus level, papillary histology and the use of postoperative systemic therapy were independently associated with worse cancer specific survival. Conclusions: In our multi-institutional series of patients with renal cell cancer who underwent radical nephrectomy and tumor thrombectomy, almost half of the patients had synchronous lymph node or distant organ metastasis. Survival was superior in patients with solitary distant metastasis compared to isolated lymph node disease. References 1 : Renal cell carcinoma with retroperitoneal lymph nodes. Impact on survival and benefits of immunotherapy. Cancer2003; 97: 2995. Google Scholar 2 : Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol1999; 17: 2530. Crossref, Medline, Google Scholar 3 : Development of accurate models for individualized prediction of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma. Eur Urol2013; 63: 947. Google Scholar 4 : Can we better select patients with metastatic renal cell carcinoma for cytoreductive nephrectomy?. Cancer2010; 116: 3378. Google Scholar 5 : Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol2004; 171: 1071. Link, Google Scholar 6 : Prognostic factors of survival and rapid progression in 782 patients with metastatic renal carcinomas treated by cytokines: a report from the Groupe Francais d'Immunotherapie. Ann Oncol2002; 13: 1460. Google Scholar 7 : A scoring algorithm to predict survival for patients with metastatic clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. J Urol2005; 174: 1759. Link, Google Scholar 8 : Number of metastatic sites rather than location dictates overall survival of patients with node-negative metastatic renal cell carcinoma. Urology2003; 61: 314. Google Scholar 9 : Classification of renal cell carcinoma: Workgroup No. 1. Union Internationale Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer1997; 80: 987. Google Scholar 10 : The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol2010; 17: 1471. Google Scholar 11 : Surgical treatment of renal cancer with vena cava extension. Br J Urol1987; 59: 390. Crossref, Medline, Google Scholar 12 : Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med2001; 345: 1655. Crossref, Medline, Google Scholar 13 : Scoring algorithm to predict survival after nephrectomy and immunotherapy in patients with metastatic renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer2003; 98: 2566. Google Scholar 14 : Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet2001; 358: 966. Crossref, Medline, Google Scholar 15 : Lack of retroperitoneal lymphadenopathy predicts survival of patients with metastatic renal cell carcinoma. J Urol2001; 166: 68. Link, Google Scholar 16 : Impact of bone and liver metastases on patients with renal cell carcinoma treated with targeted therapy. Eur Urol2014; 65: 577. Google Scholar 17 : External radiation of brain metastases from renal carcinoma: a retrospective study of 119 patients from the M.D. Anderson Cancer Center. Int J Radiat Oncol Biol Phys1997; 37: 753. Google Scholar 18 : Stereotactic radiosurgery as single-modality treatment of incidentally identified renal cell carcinoma brain metastases. World Neurosurg2010; 73: 186. Google Scholar 19 : Prognostic factors of survival for patients with metastatic renal cell carcinoma with brain metastases treated with targeted therapy: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Clin Genitourin Cancer2013; 11: 311. Google Scholar 20 : Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease: prognostic indicators of disease-specific survival. Eur Urol2007; 51: 1616. Google Scholar 21 : Renal cell carcinoma with retroperitoneal lymph nodes: role of lymph node dissection. J Urol2003; 169: 2076. Link, Google Scholar 22 : The impact of cytoreductive nephrectomy on survival of patients with metastatic renal cell carcinoma receiving vascular endothelial growth factor targeted therapy. J Urol2011; 185: 60. Link, Google Scholar 23 : Impact of histologic subtype on cancer-specific survival in patients with renal cell carcinoma and tumor thrombus. Eur Urol2014; 66: 577. Google Scholar 24 : Cytoreductive nephrectomy in patients with metastatic non-clear-cell renal cell carcinoma (RCC). BJU Int2014; 113: E67. Google Scholar 25 : Perioperative outcomes following surgical resection of renal cell carcinoma with inferior vena cava thrombus extending above the hepatic veins: a contemporary multicenter experience. Eur Urol2014; 66: 584. Google Scholar 26 : Utilization of cytoreductive nephrectomy and patient survival in the targeted therapy era. Int J Cancer2014; 134: 2245. Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byDreicer R (2018) Interdisciplinary Management of Locally Advanced and Metastatic Genitourinary Cancers: A Team SportJournal of Urology, VOL. 193, NO. 2, (389-390), Online publication date: 1-Feb-2015. Volume 193Issue 2February 2015Page: 436-442Supplementary Materials Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordsneoplasm metastasisvena cavacarcinomasurvivalinferiorprognosisrenal cellMetricsAuthor Information Derya Tilki Department of Urology, University of California, Davis School of Medicine, Sacramento, California Equal study contribution. More articles by this author Brian Hu Department of Urology, University of California, Davis School of Medicine, Sacramento, California USC/Norris Comprehensive Cancer Center, Los Angeles, California Equal study contribution. More articles by this author Hao G. Nguyen Department of Urology, University of California, Davis School of Medicine, Sacramento, California More articles by this author Marc A. Dall'Era Department of Urology, University of California, Davis School of Medicine, Sacramento, California More articles by this author Roberto Bertini Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy More articles by this author Joaquín A. Carballido Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain More articles by this author Thenappan Chandrasekar Department of Urology, University of California, Davis School of Medicine, Sacramento, California More articles by this author Thomas Chromecki Department of Urology, Medical University of Graz, Graz, Austria More articles by this author Gaetano Ciancio Miami Transplant Institute, University of Miami, Miami, Florida More articles by this author Siamak Daneshmand USC/Norris Comprehensive Cancer Center, Los Angeles, California More articles by this author Paolo Gontero Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy More articles by this author Javier Gonzalez Department of Urology, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain More articles by this author Axel Haferkamp Department of Urology, University of Frankfurt, Frankfurt, Germany More articles by this author Markus Hohenfellner Department of Urology, University of Heidelberg, Heidelberg, Germany More articles by this author William C. Huang Department of Urology, New York University School of Medicine, New York, New York More articles by this author Theresa M. Koppie Department of Urology, Oregon Health & Science University, Portland, Oregon More articles by this author Estefania Linares Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain More articles by this author C. Adam Lorentz Department of Urology, Emory University, Atlanta, Georgia More articles by this author Philipp Mandel Institute of Empirical Economic Research, University of Leipzig, Leipzig, Germany More articles by this author Juan I. Martinez-Salamanca Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain More articles by this author Viraj A. Master Department of Urology, Emory University, Atlanta, Georgia More articles by this author Rayan Matloob Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy More articles by this author James M. McKiernan Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York More articles by this author Carrie M. Mlynarczyk Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York More articles by this author Francesco Montorsi Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy More articles by this author Giacomo Novara University of Padua, Padua, Italy More articles by this author Sascha Pahernik Department of Urology, University of Heidelberg, Heidelberg, Germany More articles by this author Juan Palou Department of Urology, Fundació Puigvert, Barcelona, Spain More articles by this author Raj S. Pruthi Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Krishna Ramaswamy Department of Urology, New York University School of Medicine, New York, New York More articles by this author Oscar Rodriguez Faba Department of Urology, Fundació Puigvert, Barcelona, Spain More articles by this author Paul Russo Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York More articles by this author Shahrokh F. Shariat Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria More articles by this author Martin Spahn University of Würzburg, Würzburg, Germany More articles by this author Carlo Terrone Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy More articles by this author William Thieu Department of Urology, University of California, Davis School of Medicine, Sacramento, California More articles by this author Daniel Vergho University of Würzburg, Würzburg, Germany More articles by this author Eric M. Wallen Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Evanguelos Xylinas Department of Urology, Weill Cornell Medical Center, New York, New York More articles by this author Richard Zigeuner Department of Urology, Medical University of Graz, Graz, Austria More articles by this author John A. Libertino Department of Urology, Lahey Clinic, Burlington, Massachusetts More articles by this author Christopher P. Evans Department of Urology, University of California, Davis School of Medicine, Sacramento, California More articles by this author Expand All Advertisement PDF downloadLoading ...