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SHR Neuro Cancer Cardio Lipid Metab Microb

Maisel, F; Smolle, MA; Mollnar, S; Riedl, JM; Barth, DA; Seles, M; Terbuch, A; Rossmann, CH; Eisner, F; Mannweiler, S; Hutterer, G; Zigeuner, R; Pummer, K; Smolle-Jüttner, FM; Lindenmann, J; Stotz, M; Gerger, A; Jost, PJ; Bauernhofer, T; Pichler, M; Posch, F.
Benefit of Metastasectomy in Renal Cell Carcinoma: A Propensity Score Analysis.
Clin Genitourin Cancer. 2022; 20(4):344-353 Doi: 10.1016/j.clgc.2022.03.010
Web of Science PubMed FullText FullText_MUG

 

Leading authors Med Uni Graz

Maisel Franziska

Posch Florian

Co-authors Med Uni Graz

Barth Dominik Andreas

Bauernhofer Thomas

Eisner Florian

Gerger Armin

Hutterer Georg

Jost Philipp

Lindenmann Jörg

Mannweiler Sebastian

Pichler Martin

Pummer Karl

Riedl Jakob

Seles Maximilian

Smolle Maria Anna

Smolle-Juettner Freyja-Maria

Stotz Michael

Terbuch Angelika

Zigeuner Richard

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Abstract:

INTRODUCTION: To quantify the magnitude of benefit of metastasectomy as compared to medical treatment alone in patients with metastatic renal cell carcinoma (mRCC). PATIENTS AND METHODS: We therefore conducted a propensity score analysis of overall survival (OS) in 106 mRCC patients with metachronous metastasis, of whom 36 (34%) were treated with metastasectomy, and 70 (66%) with medical therapy alone. RESULTS: The most frequent metastasectomy procedures were lung resections (n = 13) and craniotomies (n = 6). Median time-to-progression after metastasectomy was 0.7 years (25th-75th percentile: 0.3-2.7). After a median follow-up of 6.2 years and 63 deaths, 5-year OS estimates were 41% and 22% in the metastasectomy and medical therapy group, respectively (log-rank P = .00007; Hazard ratio (HR) = 0.38, 95%CI: 0.21-0.68). Patients undergoing metastasectomy had a significantly higher prevalence of favorable prognostic factors, such as fewer bilateral lung metastases and longer disease-free intervals between nephrectomy and metastasis diagnosis. After propensity score weighting for these differences and adjusting for immortal time bias, the favorable association between metastasectomy and OS became much weaker (HR = 0.62, 95%CI: 0.39-1.00, P = .050). Propensity-score-weighted 5-year OS estimates were 24% and 20% in the metastasectomy and medical therapy group, respectively (log-rank P = .001). In exploratory analyses, the benefit of metastasectomy was confined to patients who achieved complete resection of all known metastases. CONCLUSION: Within the limitations of an observational study, these findings support the concept of metastasectomy being associated with an OS benefit in mRCC patients. Metastasectomies not achieving complete resection of all known lesions are likely without OS benefit.

Find related publications in this database (using NLM MeSH Indexing)

Carcinoma, Renal Cell - administration & dosage

Humans - administration & dosage

Kidney Neoplasms - pathology

Metastasectomy - methods

Nephrectomy - methods

Prognosis - administration & dosage

Propensity Score - administration & dosage

Retrospective Studies - administration & dosage

Survival Rate - administration & dosage

Find related publications in this database (Keywords)

Surgery

Metastasectomy

Renal cell carcinoma

Survival

Propensity score analysis

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