Introduction. The differences in progression-free survival (PFS) and overall survival (OS) depending on the line of systemic therapy, the timing of the onset of metastases, and Heng prognostic groups in patients with metastatic renal cell carcinoma (mRCC) remain unclear. This leads to the search for new prognostic factors or their combinations, depending on the characteristics of the metastatic disease.Objective. To identify prognostic factors affecting survival rates in patients with synchronous and metachronous renal cell carcinoma metastases.Materials and methods. A retrospective analysis of 934 patients with mPCC treated in the period 2006 to 2020 was performed, of which 319 (34.2%) patients were assigned to the intermediate prognosis group, and 388 (41.5%) to the unfavorable prognosis group. Synchronous metastases (Smts) and metachronous metastases (Mmts) were detected in 380 (40.7%) and 554 (59.3%) patients, respectively. The clinical and morphological characteristics of the tumor were analyzed, as well as laboratory parameters. Statistical analysis was carried out using Statistica 10.0 software («StatSoft Inc.», Tulsa, OK, USA ) by constructing Kaplan-Meyer curves and survival tables, building a mathematical survival model.Results. The 3-year and 5-year OS of Smts-patients and Mmts-patients were 40.3% and 82.5%, 18.8% and 64.3% respectively. The median OS was 25 and 88 months, respectively (p < 0.001). The 3-year and 5-year PFS rates in Mmts-patients were 60.5% and 55.7%, respectively. In Smts-patients, PFS was only 9 months, compared with a median PFS of 60 months in Mmts-patients (p < 0.001). Anemia and elevated erythrocyte sedimentation rate were observed more frequently in Smts-patients. Mmts-patients were more likely to have normal platelet and alkaline phosphatase counts. Smts-patients more often had an unfavorable prognosis according to Heng and ECOG status, a higher T stage, a low tumor differentiation, and histologically, non-clear cell carcinoma variants, the presence of lymphogenous metastases, and an increased number of organs with metastatic lesions (p < 0.001). In univariate and multivariate analyses, OS in Smts- and Mmts-patients, anemia, and poor Heng prognosis were the only statistically significant prognostic factors. In a univariate analysis of OS of Smts-patients, increases in elevated erythrocyte sedimentation platelets, and alkaline phosphatase were significant adverse prognostic factors (p < 0.001).Conclusion. Research into new prognostic factors and their combinations, focusing on the specifics of the metastatic disease itself, will improve prediction outcomes and optimize systemic treatment outcomes.

BACKGROUND: Currently there are practically no works in the literature to assess the outcomes of systemic therapy in patients with solitary, single and multiple metastases of renal cell carcinoma. AIM: The aim of the study was to analyze the outcomes of systemic drug therapy of the first line in patients with solitary, single and multiple metastases of renal cell carcinoma. MATERIALS AND METHODS: The data of 981 patients with metastatic renal cell carcinoma who underwent systemic therapy of the first line at the City Oncological Hospital No. 62 in Moscow and the City Oncological Dispensary in St. Petersburg from 2006 to 2022 were retrospectively analyzed. All patients underwent clinical, laboratory and pathomorphological examination. 90 (9.2%) patients had solitary metastases, 252 (25.7%) single metastases and 639 (65.1%) multiple metastases. An analysis was made of the outcomes of 1st line therapy, which were conditionally divided into favorable, including all cases of complete response, partial response and stabilization, and unfavorable progression during treatment, death or deregistration. Subsequently patients who had previously received chemotherapy or cytokine treatment were excluded from the analysis. RESULTS: Complete response (3.3%) and deregistration (5.56%) were more often observed in patients with solitary metastases, stabilization more often occurred in patients with single metastases (51.1%), partial response (9.4%) and death (6.2%) in patients with multiple metastases. In patients with multiple metastases treated with immune checkpoint inhibitors a partial response was observed in almost half of the cases. Stabilization and progression were observed in almost the same percentage of cases (about a quarter of cases), and only two patients had a fatal outcome, which is slightly lower than in patients receiving tyrosine kinase inhibitors. Frequent outcomes when using tyrosine kinase inhibitors were stabilization of the process (40.72% of cases) or progression (38.72%), a complete and partial response was rarely recorded. Significant differences in the occurrence of favorable and unfavorable outcomes were revealed in patients with multiple metastases, depending on the number of affected organs and the prescribed drug. When comparing the results of systemic therapy of the first line, a higher efficiency of tyrosine kinase inhibitors was observed in solitary metastases of tumors with a high and moderate degree of differentiation. Systemic therapy of G3 tumors with solitary metastases had low efficacy in the appointment of tyrosine kinase inhibitors in 27.27% of patients. Higher efficiency was noted in single and multiple metastases. The effectiveness of immune checkpoint inhibitors was revealed in 70.6% of patients with single and multiple metastases. CONCLUSIONS: When choosing systemic therapy for metastatic renal cell carcinoma in clinical practice, it is necessary to take into account such prognostic factors as histological variants, the degree of differentiation of the tumor and the number of affected organs.

Introduction. Most patients with metastatic renal cell carcinoma (mRCC) who received systemic therapy are classified into as intermediate risk group according to the International mRCC Database Consortium (IMDC) assessment. However, survival differs in patients with one and two unfavourable prognostic risk factors.Objective. To analyze the impact of possible clinical and laboratory parameters on survival in mRCC patients with intermediate prognosis according to IMDC in the presence of one or two unfavourable prognostic risk factors.Materials & methods. A retrospective analysis of data from 316 mRCC patients with intermediate prognosis receiving systemic therapy was carried out. The presence and effect on survival of the following laboratory parameters were compared: hemoglobin, neutrophil count, LDH, platelet count, alkaline phosphatase, serum calcium level, ESR, and emphasis was also placed on the time of metastases appearance. Overall survival (OS), post-progression survival (PPS), and 3- and 5-year survival were evaluated.Results. The overall 3- and 5-year survival rate for subgroups with one and two unfavourable prognostic risk factors were 85.2%  ±  1.8% and 58.1  ±  1.6%; 79.1%  ±  1.7% and 35.6  1.6%, respectively (p < 0.001). Three- and 5-year PPS for both subgroups amounted to 66.1%  ±  1.6% and 21.8%  ±  1.4%; 45.2%  ±  1.5% and 12.2%  ±  1.3%, respectively (p < 0.001). Median for OS was 61 and 51 months and PPS was 50 and 32 months respectively (p <0.001). No statistically significant difference was found in the frequency of gradations of the investigated laboratory indicators with a predictive effect on prognosis, depending on the number of a unfavourable prognostic risk factors. There were also no significant differences in survival rates when laboratory parameters deviated from the normal, except for hemoglobin: OS in patients with one prognostic factor is significantly higher with normal hemoglobin (p < 0.05). In the future, considering the absence of influence of the selected factors on survival rates with their obvious significant differences in patients with one and two prognostic factors, the influence of the time of appearance of metastases (synchronous / metachronous) was analysed: all survival parameters were significantly worse in patients with synchronous metastases. Furthermore, OS in patients with metachronous metastases with the same relapse-free period was significantly better in patients with one prognostic factor according to IMDC.Conclusions. The presence of one or two prognostic factors significantly affects the indicators of 3 and 5-year overall survival and PPS in patients with an intermediate prognosis of mRCC, while laboratory parameters do not affect survival, except for hemoglobin levels, the time of metastases appearance has a significant effect, and the time of metastases appearance has a significant effect.

BACKGROUND: Renal cell cancer is complicated with bone metastases quite often, which are determined in a third of patients at the time of diagnosis of the primary tumor. The development of skeletal complications causes the complexity of managing such patients, which requires optimizing treatment tactics using combined methods and improving the quality of life after treatment. AIM: The aim of this study is to assess the quality of life of renal cell cancer patients with single metastases in the bones before and after surgical treatment in combination with targeted therapy and without it. MATERIALS AND METHODS: The study included 62 patients with single bone metastases of renal cell cancer with the presence of skeletal related events. 20 patients (group 1) underwent surgical treatment of metastases after surgery on the primary focus in combination with targeted therapy, 42 patients (group 2) underwent only surgical treatment of metastases. The quality of life was assessed using the EORTC QLQ-C30 questionnaire before and after surgery within and between groups. RESULTS: Comparison of the survey influence on life quality in group 1 before and after treatment revealed that 8 out of 30 indicators of the EORTC QLQ-C30 questionnaire did not show a statistically significant change. These include: any restrictions in daily activities, as well as doing what you like, decreased appetite, nausea, shortness of breath, diarrhea, fatigue, financial difficulties. The remaining 22 indicators of the scale showed a statistically significant improvement. Comparison of quality of life indicators in group 2 before and after treatment showed that for 3 out of 30 indicators of the EORTC QLQ-C30 questionnaire, no statistically significant changes were registered, among them: the severity of pain syndrome, the presence of financial difficulties and health status over the past week. Statistically significant improvement was revealed for the remaining 27 indicators of the scale. Prior to treatment, difficulties in taking a short walk, doing daily chores, doing favorite things are more pronounced in group 1, and the need for rest in group 2 patients. After surgery, the indicators associated with daily activity were worse in group 1 patients, while the severity of the pain syndrome, its effect on daily activity, the need for rest, a sense of tension, and the effect on the emotional background were more noticeable in group 2 patients. Both before and after surgery, group 1 patients had a better assessment of both their health and quality of life over the past week. CONCLUSIONS: The comparative analysis of the treatment confirmed our hypothesis that the most rational and effective combination is an active surgical tactic in combination with targeted therapy for bone oligometastases of renal cell cancer.

Background. Currently, treatment tactics for oligometastatic renal cancer are a debatable topic due to relatively localized process and high risk of skeletal-related events (SRE). Therefore, the effect of treatment on quality of life of these patients is an important subject.Aim. To evaluate quality of life of patients with solitary renal cancer metastases in the bones before and after surgical treatment in combination with targeted therapy and without it.Materials and methods. The study included 64 patients with solitary bone metastases and symptoms of SRE. The patients underwent surgical treatment due to solitary bone metastases of renal cancer in combination with targeted therapy (1st group; n = 25) and without targeted therapy (2nd group; n = 39). The effects of surgical treatment on patients’ condition were evaluated using the EORTC-QLQ-C30 questionnaire.Results. In the 1st group, no statistically significant differences were shown for 8 of 30 indicators of the EORTC-QLQ-C30 questionnaire: restrictions in daily activities, dyspnea, appetite loss, nausea, vomiting, fatigue, tension, financial difficulties. The rest of the indicators showed statistically significant shift toward improvement. In the 2nd group, 7 of 30 indicators did not show statistically significant differences: restrictions in daily activities, dyspnea, sleep disorders, appetite loss, diarrhea, tension, financial difficulties. The rest of the questionnaire points also showed improvement (especially in decreased pain syndrome). In patients of the 2nd group before and after surgery, need for rest, fatigue, appetite loss and restrictions in performing work were more pronounced than in the 1st group. Additionally, after surgery patients of this group required more time in the chair and had more frequent diarrhea, while prior to surgery they complained more of nausea and fatigue. The last 2 parameters evaluating overall quality of life were higher in the 1st group before and after surgery which shows better baseline condition of these patients which was not affected by the treatment.Conclusion. Therefore, surgical treatment of renal cancer bone metastases both in combination with targeted therapy and without it significantly improves quality of life according to the results of quality of life evaluation using the EORTC-QLQ-C30 questionnaire in patients of the studied groups.