Distribution of metastatic sites in renal cell carcinoma: a population-based analysis

Bianchi, Marco; Sun, Maxine; Jeldres, Claudio; Shariat, Shahrokh F.; Trinh, Quoc Dien; Briganti, Alberto; Tian, Zhe; Schmitges, Jan; Graefen, Markus; Perrotte, Paul; Menon, Mani; Montorsi, Francesco; Karakiewicz, Pierre I.

doi:10.1093/annonc/mdr362

Cited by 529 publications

(417 citation statements)

References 22 publications

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“…17 Bianchi and colleagues found that a greater incidence of bone metastases was related to the thoracic extension of tumour spread; this was 10% in patients with exclusive abdominal metastases and 49% in patients with abdominal, thoracic, and brain metastases. 18 Our study shows the adverse prognostic role of bone metastases during the advanced phases of disease when patients have received more lines of therapy; we also report that bone metastases did not affect the activity of EV over SO. In fact, the decreased risk of death was comparable in iacovelli et al…”

Section: Discussionsupporting

confidence: 59%

Bone metastases affect prognosis but not effectiveness of third-line targeted therapies in patients with metastatic renal cell carcinoma

Iacovelli

Santini

Rizzo

et al. 2015

CUAJ

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Introduction: Treatment of metastatic renal cell carcinoma (mRCC) has improved with the use of targeted therapies, but bone metastases continue to be negative prognostic factor. Methods: Patients with mRCC treated with everolimus (EV) or sorafenib (SO) after two previous lines of targeted therapies were included in the analysis. Overall survival (OS) and progressionfree survival (PFS) were assessed based on the presence of bone metastases and type of therapy; they were also adjusted based on prognostic criteria. Results: Of the 233 patients with mRCC, 76 had bone metastases. Of the 233 patients, EV and SO were administered in 143 and 90 patients, respectively. Median OS was 10.4 months in patients with BMs and 17.4 months in patients without bone metastases (p = 0.002). EV decreased the risk of death by 18% compared to SO (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.74-0.91; p < 0.001), with comparable effects in patients with or without bone metastases. In the same manner, EV decreased the risk of progression by 12% compared to SO (adjusted HR 0.88, 95% CI 0.82-0.96; p = 0.002), but this difference was not significant in patients without bone metastases. The major limitations of the study are its retrospective nature, the heterogeneity of the methods to detect bone metastases, and the lack of data about patients treated with bisphosphonates. Conclusions: The relative benefit of targeted therapies in mRCC is not affected by the presence of bone metastases, but patients without bone metastases have longer response to therapy and overall survival. IntroductionThe skeleton is commonly affected by metastatic cancer. Genitourinary tumours, such as prostate and renal cell carcinoma (RCC), are particularly likely to spread to the bone. This represents the first and the fourth causes of bone metastases at post-mortem examination, with an incidence rate of 70% and 35% of cases, respectively.1 In renal cancer, bone metastases represent the second most common site of distant metastatic spread (after lung).2 Generally, the most frequent sites are pelvis, spine and ribs.3-6 Skeletal involvement in RCC is an aggressive, lytic process causing significant morbidity from skeletal-related events (SREs).3 In mRCC, SREs have been related to decreased functional independence, loss of autonomy and decreased quality of life compared with bone metastases from other tumours. During the last decade some targeted therapies have been approved for mRCC; 8 these can be classified as follows: (1) inhibitors of the vascular endothelial growth factor (VEGF) (i.e., bevacizumab in combination with interferon) or its receptor (VEGFR) (i.e., sorafenib, sunitinib, pazopanib, axitinib), and (2) mTOR inhibitors (mTORi) (i.e., temsirolimus and everolimus).Current guidelines recommend VEGF/VEGFR inhibitors as first-line therapy and temsirolimus in poor-risk patients, while there is no univocal indication for mTOR or VEGFR inhibitors as subsequent lines.9-12 Given the increasing incidence of RCC, improvements in overall surviv...

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Section: Discussionsupporting

confidence: 59%

Bone metastases affect prognosis but not effectiveness of third-line targeted therapies in patients with metastatic renal cell carcinoma

Iacovelli

Santini

Rizzo

et al. 2015

CUAJ

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“…At diagnosis, 57-65% of patients with metastatic renal cell carcinoma have single sites; the percentage of patients with single sites increases with age. 10 Estimates suggest that 25% of patients with metachronous metastasis might be candidates for local treatment. 12 For synchronous metastatic disease, this proportion may be less than 10%.…”

Section: Discussionmentioning

confidence: 99%

“…Despite lymph nodes being the third metastatic site in 21·8% of patients, 10 we identifi ed few studies reporting Review on only subgroups of patients who underwent nodal metastasectomy, compared with either no or incomplete resection. Isolated metachronous nodal metastases are rare and most patients harbour additional extensive metastatic disease at multiple sites, 74 precluding complete metastasectomy, which might explain the low number of comparative retrospective studies retrieved.…”

Section: Discussionmentioning

confidence: 99%

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Local treatments for metastases of renal cell carcinoma: a systematic review

Dabestani

Marconi

Hofmann

et al. 2014

The Lancet Oncology

288

205

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Local treatment of metastases such as metastasectomy or radiotherapy remains controversial in the treatment of metastatic renal cell carcinoma. To investigate the benefi ts and harms of various local treatments, we did a systematic review of all types of comparative studies on local treatment of metastases from renal cell carcinoma in any organ. Interventions included metastasectomy, radiotherapy modalities, and no local treatment. The results suggest that patients treated with complete metastasectomy have better survival and symptom control (including pain relief in bone metastases) than those treated with either incomplete or no metastasectomy. Nevertheless, the available evidence was marred by high risks of bias and confounding across all studies. Although the fi ndings presented here should be interpreted with caution, they and the identifi ed gaps in knowledge should provide guidance for clinicians and researchers, and directions for further research.

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“…Five-year survival for disseminated RCC is estimated at less than 10% [2]. The most common metastatic locations of RCC are lungs (76%), regional lymph nodes (66%), bones (42%), liver (41%), and brain (8%) [3,4]. In Poland, about 2500 people die every year from disseminated RCC [5].…”

Section: Introductionmentioning

confidence: 99%

Conjunctival metastasis of a renal cell carcinoma in a 59-year-old man – clinicopathological case report

Dernoga¹,

Rospond-Kubiak²,

Kocięcki³

et al. 2016

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The aim of the study was to present a rare case of conjunctival metastasis of a renal cell carcinoma. A 59-year-old man presented in 2012 with rapidly growing, painless, and occasionally bleeding right eye conjunctival tumour. The patient had a history of advanced renal cell carcinoma diagnosed 3 weeks previously. The conjunctival tumour was resected, and histopathological report confirmed the working diagnosis of a metastatic tumour. The patient received palliative radiation to the central nervous system but died from disseminated disease 8 weeks later. Conjunctival metastasis of a renal cell carcinoma is exceedingly rare. It appears in a stage of disseminated disease.

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Distribution of metastatic sites in renal cell carcinoma: a population-based analysis

Cited by 529 publications

References 22 publications

Bone metastases affect prognosis but not effectiveness of third-line targeted therapies in patients with metastatic renal cell carcinoma

Bone metastases affect prognosis but not effectiveness of third-line targeted therapies in patients with metastatic renal cell carcinoma

Local treatments for metastases of renal cell carcinoma: a systematic review

Conjunctival metastasis of a renal cell carcinoma in a 59-year-old man – clinicopathological case report

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