Evaluation of the effect of cytoreductive surgery on survival in patients with solitary renal cell cancer metastasis
Authors: Semenov Dmitry V. , Orlova Rashida V. , Shirokorad Valery I. , Kostritsky Stanislav V. , Gluzman Mark I. , Korneva Yulia S. 
Published: November 2023

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.