Clinical Oncology: Outcomes & Complications
Moderated Poster Session
MP23-5 - A retrospective study of the effect of metastasectomy on prognostic survival according to the metastatic organs in patients with metastatic renal cell carcinoma
Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 253
Sung Han Kim, PhD
Department of Urology, Prostate Cancer Center, National CanceNational CAncer Centerr Center, Goyang, Korea
Biometrics Research Branch, Research Institute, National Cancer Center,Goyang, Korea
Department of Urology, Prostate Cancer Center, National Cancer Center, Goyang, Korea
Introduction & Objective : Patients with metastatic RCC (mRCC) have diverse systemic symptoms according to the existence of metastatic organs, and mRCC is treated using a multimodality approach to improve the prognostic survival, including overall survival (OS) and progression-free survival (PFS).The aim of this study was to evaluate the effects of metastasectomy on OS and PFS according to metastatic organs in patients with mRCC.
Methods : Between 2005–2017, the medical records of 273 patients with mRCC were analyzed retrospectively to evaluate prognostic outcomes according to metastatic organs, and the therapeutic modalities, including nephrectomy (175, 64.3%), metastasectomy (83, 30.4%), radiation therapy (114, 41.8%), and embolization (38, 14.0%). The Cox proportional hazard model was used to evaluate the prognostic significance of metastasectomy on PFS and OS and the Kaplan–Meier method with a log rank test was used to compare the groups treated with different modalities for different metastatic organs. Statistical significance was achieved with a p-value <0.05.
Results : The median age, PFS, and OS among 273 patients were 57 year, 11.6 and 19.9 months, respectively. The ratio of synchronous-to-metachronous mRCC and of synchronous-to-staged metastasectomy with nephrectomy were 161:112 (59%:41%) and 5:78 (6.0:94.0%), respectively. The proportions of lung, liver, bone, and brain metastases were 215 (79.3%), 64 (23.6%), 116 (42.8%), and 47 (17.6%), respectively. Patients in the metastasectomy group showed significantly longer PFS (9.6 vs. 20.2 months) and OS (12.8 vs. 32.0 months) than those in the non-surgery group (p<0.05). Patients in the metastasectomy group were younger, and exhibited a lower rate of T3–4, nuclear grade 3–4, and non-clear cell histology compared to those in the non-surgery group (p<0.05). The survival outcomes according to the metastatic organs showed that liver metastasis was the only significant risk factor for both PFS (hazard ratio (HR) 1.67) and OS (HR 1.74) (p<0.001). The combination of liver and lung metastases most significantly affected the PFS (HR 2.21) and OS (HR 2.63) than that of any other combinations of organ metastases (p<0.05). Multivariable analysis also confirmed that metastasectomy was a significant risk factor for both PFS (HR 0.73) and OS (HR 0.58), along with significant histology and nuclear grade (p<0.05).
Conclusions : Only 30.4% of patients with mRCC undergo metastasectomy, which was found to be a significant prognostic factor of survival, while coexisting liver and lung metastases significantly conferred the poorest survival outcomes in these patients.