Introduction: Complete metastasectomy is expected to improve the survival of patients with metastatic renal cell carcinoma (mRCC). However, many patients develop re-recurrence, despite achieving complete remission with surgery.The aim of the present study was to investigate oncological outcomes such as recurrent free survival (RFS) after complete metastasectomy in patients with mRCC and analyze the predictive factors for recurrence after complete metastasectomy in the targeted therapy era.
Methods: This study included patients who underwent metastasectomy and achieved complete remission after surgery for mRCC between 2008 and 2018. All patients underwent nephrectomy or partial nephrectomy for primary lesion and were diagnosed as having RCC. Patients who received adjuvant systemic therapy after metastasectomy were excluded. Fifty-one patients were included in the final study population.
Results: The median age was 65 years. The distribution of MSKCC risk classification was favorable risk group in 22 (43%) patients, intermediate risk group in 27 (53%) patients, and poor risk group in 2 (4%) patients. Pathological subtype was clear cell RCC in 42 (82%) patients and papillary RCC in 8 (17%) patients. Tumor grades 1, 2 and 3 were observed in 5 (10%) patients, 33 (65%) patients, and 13 (25%) patients, respectively. One metastatic site was observed in 45 (88%) patients. Sarcomatoid features were found in 2 (4%) patients. The median duration from nephrectomy to metastasectomy was 32 months. The median follow-up duration was 49 months. During the study periods, 39 (74%) patients developed recurrence after complete metastasectomy, with median time from metastasectomy to tumor recurrence of 22 months. The 2- and 5-year RFS were 45% and 25%, respectively. Multivariate Cox regression revealed that =2 metastatic sites (vs. 1 site; HR=4.52; p=0.0171) and sarcomatoid features (HR=11.5; p=0.0171) were independent predictive factors for recurrence (table).
Conclusions: The number of metastatic sites and sarcomatoid features were associated with recurrence after complete metastasectomy, which suggests that careful observation is required for such patients, even after achieving complete remission with metastasectomy. Source of