Nephrology Xagena

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Management of renal cell carcinoma patients with bone metastases

Aim of a study was to investigate for the presence of existing prognostic factors in patients with bone metastases ( BMs ) from renal cell carcinoma ( RCC ) since bone represents an unfavorable site of metastasis for renal cell carcinoma ( mRCC ).

Data of patients with bone metastases from renal cell carcinoma were retrospectively collected.

Age, sex, ECOG-Performance Status ( PS), MSKCC group, tumor histology, presence of concomitant metastases to other sites, time from nephrectomy to bone metastases ( TTBM, classified into three groups: less than 1 year, between 1 and 5 years and more than 5 years ) and time from bone metastases to skeletal-related event ( SRE ) were included in the Cox analysis to investigate their prognostic relevance.

470 patients were enrolled in this analysis.

In 19 patients ( 4% ), bone was the only metastatic site; 277 patients had concomitant metastases in other sites.

Median time to bone metastases was 16 months ( range 0 - 44y ) with median overall survival of 17 months.

Number of metastatic sites ( including bone, p = 0.01 ), concomitant metastases, high Fuhrman grade ( p  less than  0.001 ) and non-clear cell histology ( p = 0.013 ) were significantly associated with poor prognosis.

Patients with TTBM more than 5 years had longer overall survival ( 22 months ) compared to patients with TTBM less than 1 year ( 13 months ) or between 1 and 5 years ( 19 months ) from nephrectomy ( p  less than  0.001 ), no difference was found between these two last groups ( p = 0.18 ).

At multivariate analysis, ECOG-PS, MSKCC group and concomitant lung or lymph node metastases were independent predictors of overall survival in patients with bone metastases.

In conclusion, the study suggest that age, ECOG-PS, histology, MSKCC score, TTBM and the presence of concomitant metastases should be considered in order to optimize the management of renal cell carcinoma patients with bone metastases. ( Xagena )

Santoni M et al, J Exp Clin Cancer Res 2015;34:10