Ferriero Mariaconsiglia, Cacciatore Loris, Ochoa Mario, Mastroianni Riccardo, Tuderti Gabriele, Costantini Manuela, Anceschi Umberto, Misuraca Leonardo, Brassetti Aldo, Guaglianone Salvatore, Bove Alfredo Maria, Papalia Rocco, Gallucci Michele, Simone Giuseppe
Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy.
Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy.
Cancers (Basel). 2023 Jun 25;15(13):3332. doi: 10.3390/cancers15133332.
The role of surgical metastasectomy (MST) in solitary or oligometastasis from renal cell carcinoma (RCC) and its impact on survival outcomes remains poorly addressed. We evaluated the impact of MST on overall survival (OS) in patients with oligometastatic (m)RCC.
The institutional renal cancer prospective database was examined for cases treated with partial or radical nephrectomy who developed metastatic disease during follow-up. Patients with evidence of clinical metastasis at first diagnosis were excluded. Patients considered unfit for MST received systemic treatment (ST); all others received MST. The impact of MST vs. the ST only cohort was assessed with the Kaplan-Meier method. Age, gender, bilaterality, histology, AJCC stage of primary tumor, surgical margins, local vs. distant metastasis and MST were included in univariable and multivariable regression analyses to assess the predictors of OS.
Overall, at a median follow-up of 16 months after primary treatment, 168 patients with RCC developed asynchronous metastasis at the adrenal gland, lung, liver, spleen, peritoneal, renal fossa, bone, nodes, brain and thyroid gland. Nine patients unfit for any treatment were excluded. The site of metastasis was treated with surgical MST (77/159, 48.4%), with or without previous or subsequent ST, while 82/159 cases (51.2%) received ST only. The 2-year, 5-year and 10-year OS probabilities were 93.8%, 82.8% and 79.5%, respectively. After multivariable analysis, MST and the primary tumor AJCC stage were independent predictors of OS probabilities ( = 0.019 and = 0.035, respectively). After Kaplan-Meier analysis, MST significantly improved OS probabilities versus patients receiving ST ( < 0.001).
The main drawbacks of our research were the small sample size from a single-tertiary referral institution, as well as the absent or different ST lines in the cohort of patients receiving MST.
When an NED status is achievable, surgical MST of mRCC significantly impacts OS, delaying and not precluding further subsequent ST.
手术切除转移灶（MST）在肾细胞癌（RCC）孤立性或寡转移性病变中的作用及其对生存结局的影响仍未得到充分研究。我们评估了MST对寡转移性（m）RCC患者总生存期（OS）的影响。
对机构性肾癌前瞻性数据库中接受部分或根治性肾切除术且在随访期间发生转移性疾病的病例进行检查。排除初诊时有临床转移证据的患者。认为不适合进行MST的患者接受全身治疗（ST）；所有其他患者接受MST。采用Kaplan-Meier法评估MST与仅接受ST的队列的影响。年龄、性别、双侧性、组织学、原发性肿瘤的美国癌症联合委员会（AJCC）分期、手术切缘、局部与远处转移以及MST被纳入单变量和多变量回归分析，以评估OS的预测因素。
总体而言，在初次治疗后的中位随访16个月时，168例RCC患者在肾上腺、肺、肝、脾、腹膜、肾窝、骨、淋巴结、脑和甲状腺发生了异时性转移。9例不适合任何治疗的患者被排除。转移部位接受了手术MST（77/159，48.4%），术前或术后有或无ST，而82/159例（51.2%）仅接受了ST。2年、5年和10年的OS概率分别为93.8%、82.8%和79.5%。多变量分析后，MST和原发性肿瘤AJCC分期是OS概率的独立预测因素（分别为 = 0.019和 = 0.035）。Kaplan-Meier分析后，与接受ST的患者相比，MST显著提高了OS概率（ < 0.001）。
我们研究的主要缺点是来自单一三级转诊机构的样本量小，以及接受MST的患者队列中缺乏或存在不同的ST方案。
当可实现无疾病证据（NED）状态时，mRCC的手术MST对OS有显著影响，可延迟且不排除进一步的后续ST。
