Prognostic Factors for Renal Cell Carcinoma With Bone Metastasis: Who Are the Long-Term Survivors?

Kume, Haruki; Kakutani, Shigenori; Yamada, Yukio; Shinohara, Mitsuru; Tominaga, Takashi; Suzuki, Motofumi; Fujimura, Tetsuya; Fukuhara, Hiroshi; Enomoto, Yutaka; Nishimatsu, Hiroaki; Homma, Yukio

doi:10.1016/j.juro.2010.12.037

Cited by 45 publications

(39 citation statements)

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“…Survival is especially short in patients who have vertebral and extraosseous metastases. 14 The introduction of tyrosine kinase inhibitors in the last few years has not only increased the overall survival of patients with RCC, but it has also decreased the incidence of brain metastases. 23 Early studies showed that dose escalation for the treatment of radioresistant spine metastases may be useful.…”

Section: Discussionmentioning

confidence: 99%

Single-fraction stereotactic body radiotherapy for spinal metastases from renal cell carcinoma

Balagamwala

Angelov

Koyfman

et al. 2012

SPI

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Object Stereotactic body radiotherapy (SBRT) has emerged as an important treatment option for spinal metastases from renal cell carcinoma (RCC) as a means to overcome RCC's inherent radioresistance. The authors reviewed the outcomes of SBRT for the treatment of RCC metastases to the spine at their institution, and they identified factors associated with treatment failure. Methods Fifty-seven patients (88 treatment sites) with RCC metastases to the spine received single-fraction SBRT. Pain relief was based on the Brief Pain Inventory and was adjusted for narcotic use according to the Radiation Therapy Oncology Group protocol 0631. Toxicity was scored according to Common Toxicity Criteria for Adverse Events version 4.0. Radiographic failure was defined as infield or adjacent (within 1 vertebral body [VB]) failure on follow-up MRI. Multivariate analyses were performed to correlate outcomes with the following variables: epidural, paraspinal, single-level, or multilevel disease (2–5 sites); neural foramen involvement; and VB fracture prior to SBRT. Kaplan-Meier analysis and Cox proportional hazards modeling were used for statistical analysis. Results The median follow-up and survival periods were 5.4 months (range 0.3–38 months) and 8.3 months (range 1.5–38 months), respectively. The median time to radiographic failure and unadjusted pain progression were 26.5 and 26.0 months, respectively. The median time to pain relief (from date of simulation) and duration of pain relief (from date of treatment) were 0.9 months (range 0.1–4.4 months) and 5.4 months (range 0.1–37.4 months), respectively. Multivariate analyses demonstrated that multilevel disease (hazard ratio [HR] 3.5, p = 0.02) and neural foramen involvement (HR 3.4, p = 0.02) were correlated with radiographic failure; multilevel disease (HR 2.3, p = 0.056) and VB fracture (HR 2.4, p = 0.046) were correlated with unadjusted pain progression. One patient experienced Grade 3 nausea and vomiting; no other Grade 3 or 4 toxicities were observed. Twelve treatment sites (14%) were complicated by subsequent vertebral fractures. Conclusions Stereotactic body radiotherapy for RCC metastases to the spine offers fast and durable pain relief with minimal toxicity. Stereotactic body radiotherapy seems optimal for patients who have solitary or few spinal metastases. Patients with neural foramen involvement are at an increased risk for failure.

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Section: Discussionmentioning

confidence: 99%

Single-fraction stereotactic body radiotherapy for spinal metastases from renal cell carcinoma

Balagamwala

Angelov

Koyfman

et al. 2012

SPI

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“…After analyzing 94 patients, Kume et al identified another five risk factors for predicting the survival of RCC patients with BM, including RCC sarcomatoid differentiation, spinal involvement, extra-osseous metastases, alkaline phosphatase level >1.5 times the normal level, and C-reactive protein level >0.3 mg/dL 7. To summarize the clinical characteristics of metastatic RCC and to integrate the symptom-based survival predictive system, studies evaluating the risk factors and prognostic factors for BM in RCC patients are needed.…”

Section: Introductionmentioning

confidence: 99%

Incidence of bone metastasis and factors contributing to its development and prognosis in newly diagnosed renal cell carcinoma: a population-based study

Guo

Zhang

Guo

et al. 2018

CMAR

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PurposeThe purpose of this study was to assess the incidence of and the risk factors and prognostic factors for bone metastasis (BM) in initial metastatic renal cell carcinoma (RCC) based on a large population analysis.Patients and methodsData were obtained for a total of 45,824 RCC patients recorded in the database of the Surveillance, Epidemiology, and End Results program of the National Cancer Institute between 2010 and 2014. Multivariate logistic and Cox regression analyses were used to identify the risk factors and prognostic factors associated with BM in RCC patients. Kaplan–Meier analysis was used to estimate the overall survival of RCC patients, and the difference between the survival curves was tested by log-rank tests.ResultsA total of 1,509 (3.29%) patients were diagnosed with bone metastases at initial diagnosis. Male gender, higher T stage, lymph node involvement, poor tumor grade, presence of lung, liver, and brain metastases, and the collecting duct type of RCC were positively associated with BM occurrence. The median survival time for RCC patients with bone metastases was 12.0 (95% confidence interval [CI]: 10.69–13.31) months, and the survival time for those with collecting duct, clear-cell, papillary, and chromophobe subtypes of RCC were 3 (95% CI: 0.23–5.77), 13 (95% CI: 11.60–14.40), 8 (95% CI: 5.09–10.91), and 11 (95% CI: 5.02–16.98) months; these differences were significantly different (P<0.01). Older age, higher T stage, lymph node involvement, poor tumor grade, the presence of lung, liver, and brain metastases, collecting duct RCC, and the absence of surgical treatments were the factors associated with worse prognoses.ConclusionBM was highly prevalent and significantly decreased the survival rate of RCC patients. A number of factors associated with the development and prognosis of BM were identified, and these insights provide preventive guidelines for screening and treatment of BM in RCC patients

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“…A recent meta-analysis has shown that elevated ESR levels were associated with poor overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) (Wu et al , 2011). Some studies, but not all (Magera et al , 2008), have observed that elevated ALP levels, a possible sign of paraneoplastic syndrome of RCC patients, were associated with poor RCC survival (Lee et al , 2006; Kume et al , 2011). …”

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confidence: 99%

Erythrocyte sedimentation rate and anaemia are independent predictors of survival in patients with clear cell renal cell carcinoma

et al. 2013

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Background:The 1997 international consensus conference on renal cell cancer (RCC) prognosis suggested erythrocyte sedimentation rate (ESR), alkaline phosphatase (ALP), and anaemia as prognostic biomarkers, but most studies reviewed were limited by small sample sizes.Methods:The Cox proportional hazards model was used to evaluate whether ESR, ALP, haemoglobin (Hb), and haematocrit (Hct) could predict survival outcomes in 1307 patients with clear cell RCC (ccRCC) who underwent nephrectomy during 1994–2008.Results:During a median follow-up of 43 months, we found that the patients with preoperative high levels of ESR, had a 2.10-fold (95% confidence interval (CI): 1.21–3.67) greater risk of dying from RCC compared with patients with low levels (normal range). Patients with preoperative anaemia, assessed by Hb and Hct, had a 3.11-fold (95% CI: 1.17–8.25) and 6.20-fold (95% CI: 2.30–16.72) greater risk of dying from other illnesses, respectively, compared with patients without anaemia. ALP levels were not associated with ccRCC patients' survival. These associations for ESR and anaemia were more pronounced in patients with body mass index (BMI) <25 compared with patients with BMI ⩾25 kg m−2.Conclusion:Preoperative high ESR, but not ALP, was a significant predictor for cancer-specific survival among ccRCC patients. Anaemia increases the risk of death from other illness.

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Prognostic Factors for Renal Cell Carcinoma With Bone Metastasis: Who Are the Long-Term Survivors?

Abstract: Our risk classification incorporating 5 risk factors enables accurate prediction of survival, which can be helpful to make clinical decisions in cases of renal cell carcinoma with bone metastasis.

Cited by 45 publications

References 14 publications

Single-fraction stereotactic body radiotherapy for spinal metastases from renal cell carcinoma

Single-fraction stereotactic body radiotherapy for spinal metastases from renal cell carcinoma

Incidence of bone metastasis and factors contributing to its development and prognosis in newly diagnosed renal cell carcinoma: a population-based study

Erythrocyte sedimentation rate and anaemia are independent predictors of survival in patients with clear cell renal cell carcinoma

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