Prognostic factors could aid RCC metastasectomy decisions

Oct 22 2013

By Eleanor McDermid, Senior medwireNews Reporter

Researchers have identified four factors that are associated with survival time in patients who undergo metastasectomy for metastatic renal cell carcinoma (mRCC).

The four factors, which independently predicted reduced survival, were incomplete resection, brain metastasis, C-reactive protein levels higher than 1.0 mg/dL, and having the highest histologic grade according to the Japanese criteria: grade 3, in which the nuclei of the tumor cells are larger than those of normal tubular cells.

These factors were the only independent predictors for mortality among 556 patients treated in Japanese hospitals, increasing the risk 2.15-, 3.73-, 2.45-, and 1.88-fold, respectively.

The 33 patients who had three or four of the identified risk factors had the shortest median survival time, of 10.3 months. The intermediate group of 59 patients who had any two of the prognostic factors survived for a median of 42.0 months. Patients with no risk factors, or just one, survived for a median of 105.6 months.

Researchers Yoshihiko Tomita (Yamagata University Faculty of Medicine, Japan) and co-workers say that these factors could be of help when making decisions about metastasectomy in mRCC patients.

They also comment that the overall median survival time was 80 months, compared with a reported 20–30 months in patients who do not undergo metastasectomy. “This result suggests that metastasectomy is a promising treatment for patients with mRCC, even in the modern era,” they write in Urology.

Of note, the factors that appeared to have prognostic potential in the univariate analysis included use of targeted drugs. Patients who received targeted drugs had a median survival time of 132.2 months, compared with 74.1 months for those who did not, but this difference was not significant on multivariate analysis.

The researchers believe the lack of effect may be partly because of the diversity of the patients who did not receive targeted therapies, with some treated before the drugs became available and others not needing them thanks to achieving a complete resection.

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