The role of metastasectomy in patients with renal cell carcinoma with sarcomatoid dedifferentiation: A matched controlled analysis.

Abstract

Purpose-Management of metastatic sRCC remains a therapeutic challenge with no standard treatment strategies. Our objective was to evaluate whether metastasectomy has any survival benefit in patients with metastatic sRCC treated with radical nephrectomy (RN).Patients and Methods-From an institutional database of 273 patients with sRCC treated with nephrectomy, we matched 80 patients with synchronous and asynchronous metastasis for age, ECOG performance status, histology and lymph node (LN) status. Matched pairs were then retained only if patients who did not undergo metastasectomy were comparably alive at the time of metastasectomy in matched surgical patients to reduce the bias in survival outcomes. Overall survival (OS) from nephrectomy was studied using univariable and multivariable proportional hazards regression.Results-Median OS was 8.3 months (95%CI:6.5-10.5 months) and 18.5 months (95%CI:11.5-42.9 months) for patients with synchronous and asynchronous metastases, respectively. OS for patients undergoing metastasectomy for synchronous metastasis compared to non-surgical patients was 8.4 and 8.0 months (p=0.35), respectively. Similarly, OS for patients with asynchronous metastases undergoing metastasectomy compared to non-surgical group was 36.2 and 13.7 months (p=0.29), respectively. On multivariable analysis, positive LN at nephrectomy was associated with Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflict of interest:Jose A. Karam has served as a one-time consultant to Pfizer in 2013. Christopher G. Wood has received research funding from Pfizer and served as a consultant and on its advisory board. None of these are relevant to the current manuscript. Conclusions-In the current study, there was no clear evidence of benefit for patients with sRCC undergoing metastasectomy after nephrectomy. Particularly, the group of patients with pathological LN positive disease at nephrectomy has a considerably worse survival. HHS Public Access

Role of metastasis‐directed treatment in kidney cancer

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Clinical outcomes of the sequential use of pazopanib followed by everolimus for the treatment of metastatic renal cell carcinoma: A multicentre study in Korea

“…3,6,[15][16][17][18][19][20] The benefit of cytoreductive nephrectomy is not well defined in the era of targeted therapy; however, many studies showed improved OS in patients treated with cytoreductive surgery. [22][23][24] In the present study, nephrectomy was not universally performed because this decisions was left to the discretion of the surgeon. Third, this study included Asian patients, and therefore, it is possible that outcomes were affected by ethnic differences between study populations.…”

Drug-eluting Bead transarterial chemoembolization in patients with renal carcinoma

“…Renal carcinoma is one of the most common malignancies,it ranks ninth among the most common malignancies in men and 14th among women [1].Surgical approaches are the most common treatment for the early stage patients,but about 30% of patients have metastatic disease at presentation,and metastasis was found during surgery in 40 percent of patients [2].So Surgical treatments are not suitable for patients who have large unresectable or metastatic tumours,and those who do not want to undergo traditional surgery.Along with the development of treatment,the potential role of catheter-guided transarterial embolization(TAE) has been brought to renewed attention [3].For example, catheter-guided, renal artery embolization has become a safe and accepted treatment for renal trauma and renal angiomyolipoma [4].However,the role of TAE in the treatment of renal carcinoma is not well understood.Transarterial chemoembolization with drug-eluting beads kills tumor cells via the slow release of chemotherapy drugs after embolization of the tumor area.As a new embolization material,the safety and e cacy of drug-eluting beads in the treatment of hepatocellular carcinoma have been well demonstrated [5][6].In this study,we evaluate the feasibility,safety,and cytoreductive effect of transarterial chemoembolization on renal carcinoma,using drug-eluting beads saturated with pirarubicin. This study was approved by the Ethical Committee of A liated Hospital of Jining Medical University and followed the Declaration of Helsinki principles.…”