Prognostic Factors and Survival after Pulmonary Resection of Metastatic Renal Cell Carcinoma

Hofmann, Hans‐Stefan; Neef, H; Krohe, K; Andreev, P. O.; Silber, Rolf-Edgar

doi:10.1016/j.eururo.2005.03.004

Cited by 256 publications

(199 citation statements)

References 18 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: 54%

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: 54%

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

et al. 2006

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“…[47][48][49][50][51][52][53] Multivariate analyses consistently identifi ed a pattern of prognostic factors (panel). Having a higher number of removed pulmonary metastases, 12,51,54 concomitant mediastinal nodal metastasis, 47,[51][52][53] or incomplete resection 12,48,[51][52][53][54] was associated with poorer 5-year survival of 0-24·4%. Additionally, a short diseasefree interval after nephrectomy or synchronous metastasis was associated with a poor outcome, 48,51,52,54 as was size of lung metastases.…”

Section: Discussionmentioning

confidence: 99%

“…Having a higher number of removed pulmonary metastases, 12,51,54 concomitant mediastinal nodal metastasis, 47,[51][52][53] or incomplete resection 12,48,[51][52][53][54] was associated with poorer 5-year survival of 0-24·4%. Additionally, a short diseasefree interval after nephrectomy or synchronous metastasis was associated with a poor outcome, 48,51,52,54 as was size of lung metastases. 47,52,55 A lung-specifi c prognostic score including these factors has been developed from 200 consecutive patients with pulmonary metastases; this score needs external validation.…”

Section: Discussionmentioning

confidence: 99%

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

Dabestani

Marconi

Hofmann

et al. 2014

The Lancet Oncology

287

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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“…It was possible to extract some data from the included studies to compare these outcomes, but no statistically significant difference could be demonstrated between the two groups. In general, metastasectomies for synchronous metastases are associated with shorter median survival than resection of metachronous metastases; this has been shown in the case of hepatectomy for colorectal metastases [28,29], pulmonary resection for RCC metastases [30] and adrenalectomy for metastatic non-small-cell lung cancer [31]. The previously-mentioned review of case reports and series of pancreatectomy for metastatic RCC suggest that the same principle applies [27]; our data are not consistent with this, but a dedicated study looking specifically at this question remains to be performed.…”

Section: Discussionmentioning

confidence: 99%

Pancreatectomy for metastatic disease: A systematic review

Adler

Redmond

Heneghan

et al. 2014

European Journal of Surgical Oncology (EJSO)

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Aim: Tumours rarely metastasise to the pancreas. While surgical resection of such metastases is believed to confer a survival benefit, there is limited data to support such management. We present a systematic review of case series of pancreatic metastasectomy and analysis of survival outcomes.Methods: A literature search was performed using the PubMed and Cochrane databases and the reference lists of relevant articles, searching for sizeable case series of pancreatic metastasectomy with curative intent. Data extracted included basic demographics, histological primary tumour, presentation, operative management, complications and survival, while the MINORS index was used to assess study quality.Results: 18 studies were found which met our inclusion criteria, involving 399 patients. Renal cell carcinoma (RCC) was the commonest malignancy metastasising to the pancreas, responsible for 62.6% of cases, followed by sarcoma (7.2%) and colorectal carcinoma (6.2%). While survival data was not uniformly reported, the median survival post-metastasectomy was 50.2 months, with a oneyear survival of 86.81% and five-year survival of 50.02%. Median survival for RCC was 71.7 months with 70.4% five-year survival. Median survival was similar in patients with synchronous and metachronous pancreatic metastases, but patients with additional extrapancreatic metastases had a significantly shorter survival than patients with isolated pancreatic metastases (26 versus 45 months). Study quality was poor, with a median MINORS score of 10/16. Conclusions:Within the limitations of a review of non-randomised case series, it would appear that pancreatic metastasectomy confers a survival benefit in selected patients. Better evidence is required, but may prove difficult to acquire. Key words:pancreatic metastasis, metastasectomy, pancreatectomy, metastatic renal cell cancer, 3 Introduction:

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Prognostic Factors and Survival after Pulmonary Resection of Metastatic Renal Cell Carcinoma

Cited by 256 publications

References 18 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

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

Pancreatectomy for metastatic disease: A systematic review

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