The prognostic role of key factors in renal cell carcinoma with bone metastases.

OBJECTIVES

Our study aims to investigate the factors associated with survival in patients with skeletal metastases of renal cell carcinoma and to outline the principles of managing patients with skeletal metastases using a multidisciplinary approach.

MATERIALS AND METHODS

We retrospectively reviewed 42 patients with clear cell metastatic renal cell carcinoma (mRCC) and bone metastases treated between 2005 and 2022. Demographics, tumor characteristics, metastasis patterns, surgical interventions, and systemic treatments were recorded. Survival outcomes were analyzed using the Kaplan-Meier method and the Cox proportional hazards model. Factors such as MSKCC and IMDC risk scores, the number and location of metastases, and treatment modalities were evaluated for their prognostic impact.

RESULTS

Forty-two patients with a mean age of 58.4 years and a mean follow-up period of 28.4 months were included in the study. The 1-, 2-, and 5-year overall survival (OS) rates were 73.7%, 44.2%, and 13.7%, respectively. Solitary metastases (5-year OS 80%) and complete metastasectomy (5-year OS 20.1%) were associated with significantly improved survival. Diffuse metastases (HR 22.8; p = 0.006) and oligometastases (HR 7.7; p = 0.044) were associated with higher mortality compared to solitary lesions. Neither MSKCC nor IMDC scores were independently predictive of OS in multivariate analysis. Systemic therapies, including tyrosine kinase inhibitors (TKIs), mTOR inhibitors, antiresorptive agents, and radiotherapy, did not significantly impact survival outcomes.

CONCLUSION

This study emphasizes that metastatic burden and achieving complete metastasectomy are the most critical factors for prolonged survival in metastatic renal cell carcinoma (mRCC) with bone involvement. Systemic therapies alone provide limited benefit, highlighting the need for individualized, multidisciplinary treatment strategies. Prospective studies are warranted to refine prognostic models and optimize care for this challenging patient group.