Metastasectomy in Renal Cell Carcinoma: A Multicenter Retrospective Analysis

Poel, H.G. Van Der; Roukema, Jan A.; Horenblas, Simon; Geel, A.N. van; Debruyne, F.M.J.

doi:10.1159/000019849

Cited by 187 publications

(116 citation statements)

References 16 publications

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“…The benefit of surgery has frequently been demonstrated in the past, particularly in cases of singular lung metastasis with achievement of a 'NED' situation (van der Poel et al, 1999;Hofmann et al, 2005). However, in our analysis, only 10% of the patients who had undergone metastasectomy had NED after resection.…”

Section: Discussioncontrasting

confidence: 56%

Prognostic factors in metastatic renal cell carcinoma: metastasectomy as independent prognostic variable

et al. 2006

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Prognostic and predictive factors in patients with metastatic renal cell carcinoma (MRCC) have been evaluated from untreated patients or patients on several different treatment approaches. The aim of this analysis was to define prognostic and predictive factors in patients treated uniformly with a low-dose outpatient cytokine combination. The relationship between patient-, tumour-, and treatment-related factors was analysed in 99 patients with MRCC. These features were first examined in univariate analyses, then a stepwise modelling approach based on Cox regression was used to form a multivariate model. Nuclear grade, metastasectomyeven incomplete -C-reactive protein and lactate dehydrogenase were identified as independent prognostic factors for survival. Patients assigned to three different risk groups had statistically significant survival differences (30, 22 and 6 months, respectively). A total of 43.4% had undergone metastasectomy, mostly incomplete. Risk group affiliation was correlated with response to treatment. Our findings strongly suggest the consideration of metastasectomy in the management of patients with metastatic renal cell cancer undergoing either immunotherapy or targeted treatment.

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Section: Discussioncontrasting

confidence: 56%

Prognostic factors in metastatic renal cell carcinoma: metastasectomy as independent prognostic variable

et al. 2006

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“…Based on studies describing a significantly shorter disease-specific survival of RCC patients with a short (<2 years) DFI, 8 we compared the expression profiles of ''late'' (DFI 5 years) and ''early Mets'' (DFI 9 months). The DFI was defined as the period from nephrectomy to lung metastasectomy.…”

Section: Molecular Patterns Distinguish Late and Early Metsmentioning

confidence: 99%

“…Knowing the molecular fundamentals of these phenomena would support the prognosis of patients' outcome and facilitate the decision for an appropriate therapy regime, particularly in RCC where the DFI and the number of Mets are important predictors of clinical outcome. 7,8 So far, most microarray studies on RCC metastasis comprise metastatic and nonmetastatic primary RCC. 9,10 Only a few studies include Mets of RCC to identify expression patterns associated with metastatic spread [11][12][13] since fresh-frozen metastatic lesions are rare because of their restricted surgical treatment.…”

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confidence: 99%

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Gene signatures of pulmonary metastases of renal cell carcinoma reflect the disease‐free interval and the number of metastases per patient

Wuttig

Baier²,

Fuessel

et al. 2009

Intl Journal of Cancer

100

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Our understanding of metastatic spread is limited and molecular mechanisms causing particular characteristics of metastasis are largely unknown. Herein, transcriptome-wide expression profiles of a unique cohort of 20 laser-resected pulmonary metastases (Mets) of 18 patients with clear-cell renal cell carcinoma (RCC) were analyzed to identify expression patterns associated with two important prognostic factors in RCC: the disease-free interval (DFI) after nephrectomy and the number of Mets per patient. Differentially expressed genes were identified by comparing early (DFI 9 months) and late (DFI 5 years) Mets, and Mets derived from patients with few ( 8) and multiple ( 16) Mets. Early and late Mets could be separated by the expression of genes involved in metastasis-associated processes, such as angiogenesis, cell migration and adhesion (e.g., PECAM1, KDR). Samples from patients with multiple Mets showed an elevated expression of genes associated with cell division and cell cycle (e.g., PBK, BIRC5, PTTG1) which indicates that a high number of Mets might result from an increased growth potential. Minimal sets of genes for the prediction of the DFI and the number of Mets per patient were identified. Microarray results were confirmed by quantitative PCR by including nine further pulmonary Mets of RCC. In summary, we showed that subgroups of Mets are distinguishable based on their expression profiles, which reflect the DFI and the number of Mets of a patient. To what extent the identified molecular factors contribute to the development of these characteristics of metastatic spread needs to be analyzed in further studies. ' UICC Key words: kidney cancer; lung metastases; oligonucleotide microarraysIn numerous tumour types, the development of metastases (Mets) causes the patients' death. The median survival of renal cell carcinoma (RCC) patients amounts to merely 6 to 12 months after Mets have been diagnosed. 1 RCC is the urological cancer with the highest percentage of tumour-related deaths 2 because metastasis occurs in about 60% of the patients. 3 The preferential localization of RCC Mets is the lung. 1 In contrast to the emerging development of molecular-based therapies for RCC in the last few years, 3 molecular prognostic markers are still missing. Despite the knowledge of several molecular factors involved in metastatic spread like angiogenesis, cell adhesion, invasion or migration, 4,5 little is known about specific characteristics of this complex process. These are, for example, primary-dependent site-specific metastasis, 6 varying dormancy periods of Mets originating from the same primary tumour entity causing disease-free intervals (DFI) ranging from several months to many years, or the differing number of Mets in patients with the same primary tumour. Knowing the molecular fundamentals of these phenomena would support the prognosis of patients' outcome and facilitate the decision for an appropriate therapy regime, particularly in RCC where the DFI and the number of Mets are important predictors of clinical...

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“…La mortalidad operatoria es nula en dos amplias series publicadas recientemente y la morbilidad asumible [19][20][21] . Este hecho es importante porque permite la realización, incluso, de varias toracotomías en la evolución del paciente sin aumento de la mortalidad.…”

Section: Metástasis Pulmonaresunclassified

Tratamiento quirúrgico de las metástasis del cáncer renal

Ruiz-Cerdá

Cruz

2009

Actas Urol Esp

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E l cáncer renal (CR) representa el 2% de todos los cánceres 1 . En Europa, se diagnostican cada año 40.000 pacientes con CR de los cuales fallecen aproximadamente la mitad 2 . Un tercio de los pacientes presentan un estadio localmente avanzado o diseminado en el momento del diagnóstico 3 . Además, un 25% de los pacientes portadores de enfermedad localizada intervenidos con intención curativa desarrollan progresión en forma de recidiva local o a distancia 4 .Se considera que un paciente es portador de CR con diseminación limitada (CRDL) cuando, en el momento del diagnóstico (sincrónica) o durante el seguimiento (metacrónica), presenta un sólo foco metastático o varios en un mismo órgano, siempre y cuando sean técnica, funcional y oncológicamente resecables. Si bien, cada día se está siendo más agresivo quirúrgicamente. Incluso en casos de metástasis múltiples 5 . La incidencia de metástasis en un sólo órgano (uno o múltiples focos) oscila entre 2,5-3,2% 6 . En estudios autópsicos varia entre el 8-11% 7 . Aunque la evolución es muy variable, se estima que el 35-40 % de los pacientes consiguen sobrevivir 5 años 8 . En ocasiones, la metástasis se diagnostica antes que el CR originario tras el informe anatomopatológico de un tumor considerado inicialmente primitivo del órgano donde asienta. Lo más frecuente es que se descubra de forma sincró-nica con el diagnóstico del tumor primitivo renal, o bien, durante el seguimiento post-nefrectomía. Esta circunstancia tiene importancia pronóstica porque, se ha demostrado que las tasas de supervivencia a ResumenLa extirpación completa de lesiones metastásicas pueden contribuir a mejorar el pronóstico clínico del cáncer renal. Hoy en día, se acepta que la extirpación quirúrgica de las metástasis solitarias para los pacientes con cáncer renal es la única posibilidad de supervivencia a largo plazo. Siempre que las metástasis puedan ser técnica y funcionalmente resecadas. Esta revisión se refiere a la evidencia actual sobre metástasis resecables del cáncer renal a nivel de pulmón, hígado, hueso, riñón y otros órganos.Los criterios para considerar a un paciente como candidato a la resección de metástasis son: control de tumor primario, extirpación quirúrgica de viabilidad y la falta de enfermedad sistémica. En pacientes con metástasis sincrónicas, la extirpación quirúrgica debe realizarse al mismo tiempo que la nefrectomía. El pronóstico clínico es peor cuando las metás-tasis son asíncronas. Tras la introducción de las nuevos agentes anti-angiogénicos, también se justifica la cirugía en pacientes con buena respuesta. Si bien, este enfoque sigue estando en el ámbito de la investigación.Palabras clave: Cancer renal. Metastasis. Tratamiento quirúrgico. Surgical treatment for renal cancer metastases AbstractComplete removal of metastatic lesions can contribute to improve clinical prognosis of renal cáncer. Nowadays, it is accepted that surgical extirpation of solitary metastases for patients with renal cancer is the only potential for long-term survival. Provided that the metastases c...

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Metastasectomy in Renal Cell Carcinoma: A Multicenter Retrospective Analysis

Cited by 187 publications

References 16 publications

Prognostic factors in metastatic renal cell carcinoma: metastasectomy as independent prognostic variable

Prognostic factors in metastatic renal cell carcinoma: metastasectomy as independent prognostic variable

Gene signatures of pulmonary metastases of renal cell carcinoma reflect the disease‐free interval and the number of metastases per patient

Tratamiento quirúrgico de las metástasis del cáncer renal

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