Erdoğan Furkan, Yıldırım Abdurrahman Murat, Cengiz Tolgahan, Yurtbay Alparslan, Sezgin Hicabi, Dabak Nevzat
Faculty of Medicine, Department of Orthopedics and Traumatology, Ondokuz Mayis University, Samsun, Turkey.
Clinic of Orthopedics and Traumatology, Bafra State Hospital, Samsun, Turkey.
BMC Musculoskelet Disord. 2025 Aug 2;26(1):746. doi: 10.1186/s12891-025-09021-z.
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.
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.
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.
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.
本研究旨在调查肾细胞癌骨转移患者生存的相关因素，并概述采用多学科方法管理骨转移患者的原则。
我们回顾性分析了2005年至2022年间接受治疗的42例透明细胞转移性肾细胞癌（mRCC）伴骨转移患者。记录了人口统计学、肿瘤特征、转移模式、手术干预和全身治疗情况。采用Kaplan-Meier法和Cox比例风险模型分析生存结局。评估了MSKCC和IMDC风险评分、转移灶数量和位置以及治疗方式等因素对预后的影响。
本研究纳入了42例平均年龄58.4岁、平均随访期28.4个月的患者。1年、2年和5年总生存率（OS）分别为73.7%、44.2%和13.7%。孤立性转移（5年OS 80%）和完整转移灶切除术（5年OS 20.1%）与生存显著改善相关。与孤立性病灶相比，弥漫性转移（HR 22.8；p = 0.006）和寡转移（HR 7.7；p = 0.044）与更高的死亡率相关。在多变量分析中，MSKCC和IMDC评分均不能独立预测OS。包括酪氨酸激酶抑制剂（TKIs）、mTOR抑制剂、抗吸收剂和放疗在内的全身治疗对生存结局无显著影响。
本研究强调转移负担和实现完整转移灶切除术是伴有骨转移的转移性肾细胞癌（mRCC）延长生存的最关键因素。单纯全身治疗获益有限，凸显了个体化多学科治疗策略的必要性。有必要进行前瞻性研究以完善预后模型并优化对这一具有挑战性患者群体的治疗。
