Prognostic Role of Pancreatic Metastases From Renal Cell Carcinoma: Results From an Italian Center

Grassi, Paolo; Verzoni, Elena; Mariani, Luigi; Braud, Filippo de; Coppa, Jorgelina; Mazzaferro, Vincenzo; Procopio, Giuseppe

doi:10.1016/j.clgc.2013.04.022

Cited by 41 publications

(46 citation statements)

References 18 publications

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“…The median time to PM development was almost 10 years from initial diagnosis and was peculiar to this organ. In line with other reports, patients in the PM group had a longer interval from diagnosis to TKI initiation (12), greater number of metastatic sites (12), more frequent contralateral kidney metastases (11,19) and favourable risk group assignment (10)(11)(12), but also less frequent Fuhrman grade 3-4 and bone metastases (10) (12).…”

Section: Discussionsupporting

confidence: 75%

“…As no predictive markers have been discovered for those therapies, the proper identification of baseline features independently influencing survival is essential in routine patient evaluation and fair stratification in prospective interventional trials. Within numerous factors affecting the prognosis, the presence of PM was reported to reduce the probability of death in several studies (10)(11)(12)(13). This surprising conclusion contradicts a general concept of cancer, in which greater malignant involvement of the body results in poorer outcomes.…”

Section: Discussioncontrasting

confidence: 44%

“…This is obviously a rational concept that a higher burden of malignant disease usually results in faster progression and death. In contrast to this observation, a few studies reported that patients with pancreatic metastases (PM) lived significantly longer than patients with metastases at sites other than the pancreas (10)(11)(12). It was further suggested that the presence of PM may be considered as an independent factor of favourable prognosis (11)(12)(13).…”

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confidence: 75%

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Prognostic Significance of Pancreatic Metastases from Renal Cell Carcinoma in Patients Treated with Tyrosine Kinase Inhibitors

Chrom

Stec

Bodnar

et al. 2018

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Abstract. Aim: The study aimed to define the true impact of pancreatic metastases (PM) from renal cell carcinoma on overall survival (OS) in patients treated with first-line tyrosine kinase inhibitors. Patients and Methods: Overall, 321 consecutive patients were analysed. The influence of PM on OS was assessed using the Kaplan-Meier estimator and the logrank test (unadjusted and adjusted) and two multivariabe Cox proportional hazards regressions (CPHR =0.84, p=0.603, and HR=0.66, p=0.098). Conclusion: The presence of PM was not an independent prognostic factor, but was rather an indicator of an indolent course of the disease.Renal cell carcinoma (RCC) is the most frequent type of kidney cancer and accounts for 3% of malignancies in adults. About 20% of patients with RCC have metastases at the initial diagnosis and up to half of patients develop recurrence after complete resection of the primary tumour (1-4). Nowadays, these patients are treated with systemic molecular targeted therapies (MTT) that include tyrosine kinase inhibitors (TKI) as the standard of care in first-line therapy and subsequent lines (5-6). Despite the significant improvement in efficacy of this type of drug compared to cytokine-based regimens, the treatment remains palliative in nature, i.e. aims to maximally increase patient survival with having little curative potential. Moreover, there are still no factors possessing predictive value for MTT, thus patient evaluation and prognosis is made using selected baseline characteristics. The most commonly used and validated tool for survival prediction in patients with metastatic RCC is the International Metastatic Renal Cell Database Consortium (IMDC) model. It consists of six factors independently associated with poor outcome: Karnofsky performance status (KPS) less than 80%, time from diagnosis to start of systemic treatment less than 12 months, haemoglobin level less than the lower limit of normal (LLN), serum corrected calcium level, neutrophil count and platelet count greater than the upper limit of normal (ULN). Patients are stratified into favourable-, intermediate-and poor-risk groups according to the total number of factors (0, 1-2 and 3-6, respectively) (7). Other researchers concluded that the involvement of the metastatic process in specific organs, e.g. liver or bone, as well as an increasing number of metastatic sites may be additional features of reduced survival (8,9). This is obviously a rational concept that a higher burden of malignant disease usually results in faster progression and death. In contrast to this observation, a few studies reported that patients with pancreatic metastases (PM) lived significantly longer than patients with metastases at sites other than the pancreas (10-12). It was further suggested that the presence of PM may be considered as an independent factor of favourable prognosis (11-13). This means that PM may increase the probability of survival regardless of the status of other criteria known to have an impact on the prognosis (e.g. those included in t...

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Section: Discussionsupporting

confidence: 75%

Section: Discussioncontrasting

confidence: 44%

mentioning

confidence: 75%

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Prognostic Significance of Pancreatic Metastases from Renal Cell Carcinoma in Patients Treated with Tyrosine Kinase Inhibitors

Chrom

Stec

Bodnar

et al. 2018

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“…Previous reports, regarding specifically thyroid or pancreatic metastases, have already described an association with better outcome in terms of survival [16,24]. The diagnosis of involvement of these organs is sometimes difficult, and frequently such lesions are only found after administration of an anti-VEGFR-TKI due to the density changes on computed tomography.…”

Section: Glandular Metastasesmentioning

confidence: 99%

“…The IMDC and MSKCC prognostic scores were calculated at start of second-line therapy, as well as the different factors that form the basis for these established scores (interval between diagnosis and systemic treatment, performance status, hemoglobin levels, corrected serum calcium levels, serum LDH levels, neutrophil and platelet count), presence of sarcomatoid dedifferentiation in 25% of the tumor volume [12], PFS [13] and best response on first-line therapy, the presence of bone metastases [14], brain metastases [15] or glandular metastases (defined as pancreatic, adrenal or thyroid metastases) [16], baseline C-reactive protein (CRP) levels ( or4inferior limit of normal, 5 mg/dl) [17] and albumin levels ( or4inferior limit of normal, 3.5 g/dl) [18,19] at start of second-line therapy. Associations between PFS or OS and potential prognostic factors were assessed using Kaplan-Meier estimates and the logrank test in univariate analysis.…”

Section: Methodsmentioning

confidence: 99%

Prognostic factors in second-line targeted therapy for metastatic clear-cell renal cell carcinoma after progression on an anti-vascular endothelial growth factor receptor tyrosine kinase inhibitor

Sacré

Barthélémy²,

Korenbaum³

et al. 2015

Acta Oncologica

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Submit your article to this journal Background: About 40% of metastatic clear-cell renal cell carcinoma (m-ccRCC) patients receive a second-line targeted therapy after failure of anti-vascular endothelial growth factor receptor tyrosine kinase inhibitors (anti-VEGFR-TKI). Efficacy of second-line therapy is usually limited and prognostic and predictive factors at the start of second-line therapy are lacking. To identify the subgroup of patients that will benefit from such treatment remains a challenge. Methods: We performed a multi-institutional, retrospective study of patients who received a second-line therapy after progression on an anti-VEGFR-TKI. Univariate and multivariate analyses were performed in order to identify prognostic factors for progressive disease (PD) as best response, progression-free survival (PFS) and overall survival (OS) on second-line therapy. Results: For the whole cohort of 108 patients, mOS from the start of second-line therapy was 8.9 months while mPFS on second-line therapy was 2.8 months. A total of 49/105 (47%) patients had PD, 50/105 (48%) stable disease (SD) and 6/105 (6%) a partial response (PR). On multivariate analysis, the following markers were associated with improved outcome on second-line therapy: a PFS on first-line therapy 12 months (HR for PFS: 1.961; p ¼ 0.008) (HR for OS: 1.724; p ¼ 0.037) and Fuhrman grade 1-2 tumors (HR for OS: 2.198; p ¼ 0.007). Markers associated with poorer outcome on second-line therapy were: elevated serum lactate dehydrogenase (LDH) levels (HR for PFS: 0.511; p ¼ 0.04) (HR for OS: 0.392; p ¼ 0.017), low albumin (HR for OS: 0.392; p ¼ 0.01) and elevated corrected calcium levels (HR for OS: 0.416; p ¼ 0.01). The impact on OS of the Memorial Sloan Kettering Cancer Centre (MSKCC) and International Renal Cell Carcinoma Database Consortium (IMDC) prognostic scores as calculated at start of second-line therapy was validated in our patient series. Conclusions: Duration of first-line PFS, Fuhrman grade, serum LDH levels, albumin levels, corrected calcium levels and the MSKCC and IMDC scores calculated at start of second-line therapy are prognostic factors for m-ccRCC patients treated with second-line targeted therapy.

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Solid tumor metastases to the pancreas diagnosed by FNA: A single‐institution experience and review of the literature

Smith

Odronic

Springer

et al. 2015

Cancer Cytopathology

109

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BACKGROUND: Pancreatic fine-needle aspiration (FNA) is useful for diagnosing pancreatic masses. This article describes the experience of a single institution with metastases to the pancreas sampled by FNA and provides a review of the literature. METHODS: Medical records were retrospectively searched for pancreatic FNA that showed metastatic disease. Data were gathered for the tumor size, focality, and time period between the primary tumor and the metastasis. A literature search using PubMed was performed. RESULTS: Pancreatic FNA was performed 2327 times in 14 years at the authors' institution. Twenty-two cases showed metastatic disease. The average size of the metastatic lesions in their greatest dimension was 3.7 cm (range, 1.5-6.5 cm). The majority of the tumors were unifocal (16 of 22 or 73%). A rapid onsite adequacy evaluation was performed for 13 patients (4 were diagnostic of metastasis, 3 were positive for malignant cells, 6were atypical, and none were negative). There were 14 renal cell carcinomas, 2 colonic adenocarcinomas, 1 urothelial carcinoma, 1 non-small cell lung carcinoma, 1 ovarian serous carcinoma, 1 prostatic adenocarcinoma, 1 papillary thyroid carcinoma, and 1 mesenchymal chondrosarcoma. The median time between the diagnosis of the primary tumor and the initial pancreatic metastasis was 9 years (range, concurrent diagnosis to 21 years). A literature review yielded 12 case series with a variety of metastases to the pancreas diagnosed by FNA and surgical pathology specimens. CONCLUSIONS: In agreement with prior series, the most common metastasis to the pancreas was renal cell carcinoma. A variety of other primary malignancies were also documented in this study and in the literature. Also, this article reports the first case of metastatic mesenchymal chondrosarcoma to the pancreas diagnosed by FNA. Cancer (Cancer Cytopathol) 2015;123:347-55.

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Prognostic Role of Pancreatic Metastases From Renal Cell Carcinoma: Results From an Italian Center

Cited by 41 publications

References 18 publications

Prognostic Significance of Pancreatic Metastases from Renal Cell Carcinoma in Patients Treated with Tyrosine Kinase Inhibitors

Prognostic Significance of Pancreatic Metastases from Renal Cell Carcinoma in Patients Treated with Tyrosine Kinase Inhibitors

Prognostic factors in second-line targeted therapy for metastatic clear-cell renal cell carcinoma after progression on an anti-vascular endothelial growth factor receptor tyrosine kinase inhibitor

Solid tumor metastases to the pancreas diagnosed by FNA: A single‐institution experience and review of the literature

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