OBJECTIVE: To prospectively establish objective selection criteria for metastasectomy in patients with metastatic renal cell carcinoma (mRCC). PATIENTS AND METHODS: Between 1991 and 1999, 38 patients with mRCC with responsive or stable disease after initial systemic therapy, and with potentially resectable disease, were enrolled. Patients had a metastasectomy with curative intent and received consolidative adjuvant systemic therapy. RESULTS: Of the patients enrolled, 79% had stable disease after initial systemic therapy and 21% had a partial or complete response. Most (84%) had metastasectomy of one organ site. There was surgically no evidence of disease (sNED) in 76%. Operative morbidity and mortality were acceptable and 90% of the patients received adjuvant systemic therapy. The median (95% confidence interval) survival was 4.7 (3.0-7.8) years, and the median time to progression was 1.8 (0.8-3.1) years. Eight of 38 patients (21%) remained free of disease by the end of the study. Significant predictors of outcome were lack of sNED after metastasectomy, and the presence of pulmonary metastases. The median overall survival for those who had sNED was 5.6 years, vs 1.4 years for those who did not (P < 0.001). CONCLUSIONS: Metastasectomy in patients with mRCC not progressing after systemic therapy is feasible, with acceptable morbidity. Predictive factors for long-term outcome include pulmonary metastases and sNED. Future work evaluating treatments that can convert patients into surgical candidates will increase the cure rate of patients with mRCC.
OBJECTIVE: To prospectively establish objective selection criteria for metastasectomy in patients with metastatic renal cell carcinoma (mRCC). PATIENTS AND METHODS: Between 1991 and 1999, 38 patients with mRCC with responsive or stable disease after initial systemic therapy, and with potentially resectable disease, were enrolled. Patients had a metastasectomy with curative intent and received consolidative adjuvant systemic therapy. RESULTS: Of the patients enrolled, 79% had stable disease after initial systemic therapy and 21% had a partial or complete response. Most (84%) had metastasectomy of one organ site. There was surgically no evidence of disease (sNED) in 76%. Operative morbidity and mortality were acceptable and 90% of the patients received adjuvant systemic therapy. The median (95% confidence interval) survival was 4.7 (3.0-7.8) years, and the median time to progression was 1.8 (0.8-3.1) years. Eight of 38 patients (21%) remained free of disease by the end of the study. Significant predictors of outcome were lack of sNED after metastasectomy, and the presence of pulmonary metastases. The median overall survival for those who had sNED was 5.6 years, vs 1.4 years for those who did not (P < 0.001). CONCLUSIONS: Metastasectomy in patients with mRCC not progressing after systemic therapy is feasible, with acceptable morbidity. Predictive factors for long-term outcome include pulmonary metastases and sNED. Future work evaluating treatments that can convert patients into surgical candidates will increase the cure rate of patients with mRCC.
Authors: Bernard Escudier; Tim Eisen; Walter M Stadler; Cezary Szczylik; Stéphane Oudard; Michael Siebels; Sylvie Negrier; Christine Chevreau; Ewa Solska; Apurva A Desai; Frédéric Rolland; Tomasz Demkow; Thomas E Hutson; Martin Gore; Scott Freeman; Brian Schwartz; Minghua Shan; Ronit Simantov; Ronald M Bukowski Journal: N Engl J Med Date: 2007-01-11 Impact factor: 91.245
Authors: Gary Hudes; Michael Carducci; Piotr Tomczak; Janice Dutcher; Robert Figlin; Anil Kapoor; Elzbieta Staroslawska; Jeffrey Sosman; David McDermott; István Bodrogi; Zoran Kovacevic; Vladimir Lesovoy; Ingo G H Schmidt-Wolf; Olga Barbarash; Erhan Gokmen; Timothy O'Toole; Stephanie Lustgarten; Laurence Moore; Robert J Motzer Journal: N Engl J Med Date: 2007-05-31 Impact factor: 91.245
Authors: Ricardo A Rendon; Anil Kapoor; Rodney Breau; Michael Leveridge; Andrew Feifer; Peter C Black; Alan So Journal: Can Urol Assoc J Date: 2014-05 Impact factor: 1.862
Authors: Jose A Karam; Brian I Rini; Leticia Varella; Jorge A Garcia; Robert Dreicer; Toni K Choueiri; Eric Jonasch; Surena F Matin; Steven C Campbell; Christopher G Wood; Nizar M Tannir Journal: J Urol Date: 2010-12-17 Impact factor: 7.450