Lung metastasectomy following kidney tumors: outcomes and prognostic factors from a single-center experience

Meacci, Elisa; Nachira, Dania; Congedo, Maria Teresa; Porziella, Venanzio; Chiappetta, Marco; Ferretti, Gian Maria; Iaffaldano, Amedeo; Ciavarella, Leonardo Petracca; Margaritora, Stefano

doi:10.21037/jtd.2017.05.04

Cited by 24 publications

(18 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Among 30 patients with GU metastases, there were 23 (76.6%) with metastatic renal cell carcinoma, 3 with bladder cancer, 2 with prostate cancer, and 2 with genital cancer. Similar high post-PM survival rates (5-year OS of 75%) in metastatic renal cell carcinoma have been reported by Meacci et al 14 We hypothesize that outstanding GU histology-associated OS rates observed in our cohort may be a sequel of a careful patient selection. Interestingly, our univariable Cox proportional hazard model analysis demonstrated that patients in the age of 66 years and older had significantly worse survival compared with the younger patients (5-year OS rate 33.6 vs. 54.8%, respectively; p ¼ 0.0007).…”

Section: Discussionsupporting

confidence: 90%

Surgery for Pulmonary Metastases: Long-Term Survival in 281 Patients

Dudek

Schreiner

Khalaf

et al. 2021

Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Background Despite weak evidence, pulmonary metastasectomy (PM) is widely performed with intent to improve patient survival. Our single-institution analysis aims to evaluate outcomes and to identify factors influencing survival of patients undergoing PM for metastases from wide range of primary tumors. Materials and Methods All patients undergoing curative-intent PM between 2008 and 2018 were retrospectively analyzed. The impact of factors related to primary tumor, metastases, and associated therapy on overall survival (OS) was evaluated using univariable and multivariable Cox proportional hazard models. Cutoff values of continuous variables were determined by a receiver operating characteristic analysis. Results In this study, 281 patients (178 male, median age 61 years) underwent PM. Two (0.7%) perioperative deaths and 23 (8.2%) major complications occurred. Median interval between the treatment of primary tumor and PM was 21 months. Median size of largest metastasis was 1.4 cm. After the median follow-up of 29 months, 134 patients (47.7%) had died. Five-year OS rate after first PM was 47.1%. Complete resection was achieved in 274 (97.5%) patients. Multivariable analysis identified genitourinary origin (hazard ratio [HR]: 0.30, 95% confidence interval [CI]: 0.15–0.60, p = 0.0008) as independent positive survival prognosticator; incomplete resection (HR: 3.53, 95% CI: 1.40–8.91, p = 0.0077) and age at PM of ≥66 years (HR: 1.97, 95% CI: 1.36–2.85, p = 0.0003) were negative prognosticators. Conclusion The use of PM as a part of multimodal treatment is in selected population justified. Our analysis identified age, primary tumor origin, and completeness of resection as independent survival prognosticators.

show abstract

Section: Discussionsupporting

confidence: 90%

Surgery for Pulmonary Metastases: Long-Term Survival in 281 Patients

Dudek

Schreiner

Khalaf

et al. 2021

Thorac Cardiovasc Surg

View full text Add to dashboard Cite

show abstract

“…In fact, lung IM had a 5-year OS of 82% compared with 50.4% without surgical resection. These results are similar to what was previously reported in the literature for CM (range 75% to 83.3%) [18,19]. Site-specific survival analyses were not conducted in previous studies evaluating IM [7,8,12].…”

Section: Figure 2bsupporting

confidence: 90%

Can incomplete metastasectomy impact renal cell carcinoma outcomes? A propensity score matching analysis from a prospective multicenter collaboration

Dragomir¹,

Hesswani²,

Marcq³

et al. 2021

Société Internationale D’Urologie Journal

View full text Add to dashboard Cite

Objective: To evaluate the role of incomplete metastasectomy (IM) for patients with metastatic renal cell carcinoma (mRCC) on overall survival (OS) and time to introduction of first-line systemic therapy. Methodology: Patients diagnosed with mRCC between Jan 2011 and Apr 2019 in 16 centers were selected from the Canadian Kidney Cancer information system database. We included mRCC patients who had prior nephrectomy and had received an IM (resection of at least 1 metastasis) or no metastasectomy (NM). A propensity score matching was performed to minimize selection bias. Cox proportional hazards analysis was used to assess the impact of the metastasectomy while adjusting for potential confounders. OS was assessed by Kaplan-Meier analysis. Results: A total of 138 patients with mRCC underwent IM, while 1221 patients did not. On multivariate analysis, IM did not improve OS (hazard ratio [HR] 0.96, 95% CI 0.63 to 1.45, P = 0.836) However, subgroup analyses revealed IM improved OS compared with NM when lungs were the only site involved (median time to OS not reached versus 66 months, respectively; P = 0.014). Additionally, lung metastasectomy delayed the systemic therapy compared with NM (median 41 and 13 months, respectively, P = 0.014). IM of endocrine organs (thyroid, pancreas, adrenals) or bone metastases did not impact OS. Conclusion: The role of IM for mRCC is limited. Incomplete resection of lung metastases was associated with improved OS and delayed time to introduction of systemic therapy when lungs were the sole location of metastatic disease. Despite case-matching, unknown unadjusted confounders may explain the relationship between IM and survival in this analysis.

show abstract

“…Duration decreases with compromised immune response [9]. The five and 10-year overall survival rate following pulmonary metastasectomy for metastatic renal cancer was 83% and 41.7% respectively according to Chen et al [14]and 75% and 59% respectively according to Meacciet al [15].…”

Section: Discussionmentioning

confidence: 98%