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Evaluation of the effect of cytoreductive surgery on survival in patients with solitary renal cell cancer metastasis
- Authors: Semenov D.V.1,2, Orlova R.V.1,2, Shirokorad V.I.3, Kostritsky S.V.3, Gluzman M.I.1,2, Korneva Y.S.4,5,6
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Affiliations:
- City Clinical Oncology Dispensary
- Saint Petersburg State University
- Moscow City Oncological Hospital No. 62
- Smolensk State Medical University
- North-Western State Medical University named after I.I. Mechnikov
- City Hospital No. 26
- Issue: Vol 13, No 3 (2023)
- Pages: 251-257
- Section: Original articles
- URL: https://journals.eco-vector.com/uroved/article/view/375268
- DOI: https://doi.org/10.17816/uroved375268
- ID: 375268
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Abstract
BACKGROUND: Cytoreductive nephrectomy and metastasectomy are recommended for patients with solitary renal cell carcinoma metastases.
AIM: To determine the impact of cytoreductive surgery on overall survival (OS) in patients with solitary renal cell carcinoma metastases.
MATERIALS AND METHODS: A retrospective analysis of the data of 90 patients with solitary metastases of renal cell carcinoma, who underwent systemic therapy and various types of cytoreductive surgery operations at the City Oncological Hospital No. 62 in Moscow and the City Clinical Oncological Dispensary in St. Petersburg from 2006 to 2022, was carried out. In the majority of patients with solitary metastases, G1 and G2 tumors according to Fuhrman were detected (37 patients each, 41.1%). Cytoreductive nephrectomy was performed in 16 (17.8%) patients, metastasectomy was performed in 35 (38.9%) patients, in combination with metastasectomy — in 4 (4.4%) patients, in combination with retroperitoneal lymphadenectomy — in 19 (21.1%) patients. In addition to cytoreductive surgical treatment of the primary tumor and metastases all patients received systemic therapy.
RESULTS: Cytoreductive nephrectomy and metastasectomy had a statistically significant effect on overall survival in renal cell carcinoma patients with solitary metastases. 3- and 5-year survival in patients who underwent CNE was 78.2 ± 1.7% and 40.3 ± 1.6%, while in patients without Cytoreductive nephrectomy it was only 29.2 ± 1.4% and 0%, respectively. The median overall survival was 55 months for patients who underwent cytoreductive nephrectomy and 30 months for those who did not. A similar trend was noted for the outcomes of metastasectomy. In patients after metastasectomy, 3 and 5-year overall survival was 86.3 ± 1.8% and 59.6 ± 1.6%, in patients without metastasectomy — 61.3 ± 1.6% and 19.8 ± 1.3%, respectively, median — 59 and 38 months for patients with and without metastasectomy, respectively. Statistically significant differences in the overall survival of patients with solitary metastases were revealed depending on the degree of tumor differentiation according to Fuhrman. 3- and 5-year OS of patients was 84.2 ± 1.8% and 59.9 ± 1.7%, 80.3 ± 1.8% and 46.7 ± 1.6%, 52.2 ± 1.8% and 22.2 ± 1.6% for tumors G1, G2 and G3, respectively (p = 0.009), median — 63, 56, and 31 months for G1, G2, and G3 tumors, respectively. Depending on the prognosis according to the International Metastatic Renal Cancer Database Consortium (IMDC) classification, the 3- and 5-year overall survival of patients was 83.7 ± 1.8% and 69.4 ± 1.7%, 68.8 ± 1.6% and 37.2 ± 1.5%, 23.7 ± 1.4% and 11.7 ± 1.3% for the group of good prognosis, intermediate prognosis and poor prognosis, respectively (p = 0.0001). Median overall survival was 64, 41, and 25 months for the three prognosis groups, respectively.
CONCLUSIONS: Cytoreductive nephrectomy and metastasectomy had a significant impact on overall survival in patients with solitary renal cell carcinoma metastases. The degree of tumor differentiation according to Fuhrman and prognosis according to IMDC also influenced survival rates.
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About the authors
Dmitry V. Semenov
City Clinical Oncology Dispensary; Saint Petersburg State University
Author for correspondence.
Email: sema.69@mail.ru
ORCID iD: 0000-0002-4335-8446
MD, Cand. Sci. (Med.), oncourologist; associate professor
Russian Federation, Saint Petersburg; Saint PetersburgRashida V. Orlova
City Clinical Oncology Dispensary; Saint Petersburg State University
Email: orlova_rashida@mail.ru
ORCID iD: 0000-0002-9368-5517
SPIN-code: 9932-6170
MD, Dr. Sci. (Med.), professor, chief specialist in Clinical Oncology, head of the Department of Oncology
Russian Federation, Saint Petersburg; Saint PetersburgValery I. Shirokorad
Moscow City Oncological Hospital No. 62
Email: shirokorad@bk.ru
ORCID iD: 0000-0003-4109-6451
MD, Dr. Sci. (Med.), head of the Oncourological Unit
Russian Federation, Moscow RegionStanislav V. Kostritsky
Moscow City Oncological Hospital No. 62
Email: stas.medic@bk.ru
ORCID iD: 0000-0003-4494-1489
SPIN-code: 1421-2469
oncourologist, Oncourological Unit
Russian Federation, Moscow RegionMark I. Gluzman
City Clinical Oncology Dispensary; Saint Petersburg State University
Email: Lok2008@list.ru
ORCID iD: 0000-0002-8965-8364
SPIN-code: 4229-2201
MD, Cand. Sci. (Med.), head of the Anticancer Drug Therapy Unit, associate professor in the Department of Oncology
Russian Federation, Saint Petersburg; Saint PetersburgYulia S. Korneva
Smolensk State Medical University; North-Western State Medical University named after I.I. Mechnikov; City Hospital No. 26
Email: ksu1546@yandex.ru
ORCID iD: 0000-0002-8080-904X
SPIN-code: 5169-7740
MD, Cand. Sci. (Med.), associate professor of the Department of Pathological Anatomy, pathologist of the Pathology Department
Russian Federation, Smolensk; Saint Petersburg; Saint PetersburgReferences
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