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Abstract
Purpose
One third of renal cell caricinoma (RCC) patients present with metastatic disease and 20-40% of these patients who undergo nephrectomy for clinically localized RCC will develop metastases. Eventually, the number of those patients who develop metastatic disease will increase to 30-50%. The aim of this study is to compare the efficacy and survival rate in relation to the time of performing metastasectomy and immnuochemotherapy.
Materials and Methods
We retrospectively enrolled 12 patients who had undergone radical nephrectomy, immunochemotherapy and metastasectomy between 1998 and 2007. The patients were subdivided into two groups. Group 1 included the patients who received radical nephrectomy, metastasectomy and immunochemotherapy altogether. Group 2 included the patients who developed metachronous metastases during follow-up after radical nephrectomy and so they then underwent metastasectomy and immunochemotherapy. We compared the survival rates between the two groups.
Results
The sites of initial metastasis were found to be 8 cases of lung metastasis, 2 of bone metastasis, 1 of brain metastasis and 1 of colon metastasis. The 5-year survival rate of the 5 patients from group 1 was 37.5%. In group 2, the 5-year survival rate of the 7 patients was 71.4% and the disease-free mean interval between primary resection of the kidney and metastasectomy was 36.43±7.62 months. Statistically, there was no significant difference of survival rates between the two groups.
Conclusions
The results of this study suggest that metastasectomy followed by radical nephrectomy results in a longer survival time for the patients with metastatic cancer than that of patient that undergo radical nephretomy, metastasectomy and immunotherapy at the same time. We can recommend metastasetomy any time for the RCC patients who have technical resectable metastases with possibly positive prognostic factors and a good functional condition.
Figures and Tables
Fig. 1
Comparison of the cumulative survival. The survival rate of group 2 was calculated from the time of radical nephrectomy. There was no significant difference in the survival rates of the 2 groups (p=0.447 by Kaplan Meier analysis and the log rank test).
Fig. 2
Comparison of the cumulative survival. The survival rate of group 2 was calculated from the time of metastasectomy. There was no significant difference in the survival rates of the 2 groups (p=0.704, by Kaplan Meier analysis and the log rank test).
References
1. Motzer RJ, Russo P. Systemic therapy for renal cell carcinoma. J Urol. 2000. 163:408–417.
2. Figlin RA, Pierce WC, Kaboo R, Tso CL, Moldawer N, Gitlitz B, et al. Treatment of metastatic renal cell carcinoma with nephrectomy, interleukin-2 and cytokine-primed or CD8 (+) selected tumor infiltrating lymphocytes from primary tumor. J Urol. 1997. 158:740–745.
3. Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, et al. AJCC cancer staging manual. 2002. 6th ed. New York: Springer-Verlag;323–328.
4. Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982. 6:655–663.
5. Barney JD, Churchill EJ. Adenocarcinoma of the kidney woth metastasis to the lung: cured by nephrectomy and lobectomy. J Urol. 1939. 42:269–276.
6. Alves A, Adam R, Majno P, Delvart V, Azoulay D, Castaing D, et al. Hepatic resection for metastatic renal tumors: Is it worthwhile? Ann Surg Oncol. 2003. 10:705–710.
7. Kavolius JP, Mastrorakos DP, Pavlovich C, Russo P, Burt ME, Brady MS. Resection of metastatic renal cell carcinoma. J Clin Oncol. 1998. 16:2261–2266.
8. Piltz S, Meimarakis G, Wichmann MW, Hatz R, Schildberg FW, Fuerst H. Long-term results after pulmonary resection of renal cell carcinoma metastases. Ann Thorac Surg. 2002. 73:1082–1087.
9. Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V, McGrath PC, et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med. 2001. 345:1655–1659.
10. Bennett RT, Lerner SE, Taub HC, Dutcher JP, Fleischmann J. Cytoreductive surgery for stage IV renal cell carcinoma. J Urol. 1995. 154:32–34.
11. Fallick ML, McDermott DF, LaRock D, Long JP, Atkins MB. Nephrectomy before interleukin-2 therapy for patients with metastatic renal cell carcinoma. J Urol. 1997. 158:1691–1695.
12. Atkins MB, Sparano J, Fischer RI, Weiss GR, Margolin KA, Fink KI, et al. Randomized phase II trial of high-dose interleukin-2 either alone or in combination with interferon alfa-2b in advanced renal cell carcinoma. J Clin Oncol. 1993. 11:661–670.
13. Sella A, Swanson DA, Ro JY, Putamen JB Jr, Amato RJ, Markowitz AB, et al. Surgery following response to interferon-alpha-based therapy for residual renal cell carcinoma. J Urol. 1993. 149:19–21.
14. Cerfolio RJ, Allen MS, Deschamps C, Daly RC, Wallrichs SL, Trastek VF, et al. Pulmonary resection of metastatic renal cell carcinoma. Ann Thorac Surg. 1994. 57:339–344.
15. O'dea MJ, Zincke H, Utz DC, Bernatz PE. The treatment of renal cell carcinoma with solitary metastasis. J Urol. 1978. 120:540–542.
16. Dreicer R, Galbraith SS, Davis CS, See WA. Surgical resection of metastatic renal cell carcinoma. Urol Oncol. 1997. 3:99–101.
17. Krishnamurthi V, Novick AC, Bukowski RM. Efficacy of multimodality therapy in advanced renal cell carcinoma. Urology. 1998. 51:933–937.
18. Tanguay S, Swanson DA, Putnam JB Jr. Renal cell carcinoma metastatic to lung: potential benefit in the combination of biological therapy and surgery. J Urol. 1996. 156:1586–1589.
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