Korean J Urol.  2008 Jan;49(1):1-6.

The Role of Metastasectomy and Immunochemotherapy in Multimodal Therapy for Metastatic Renal Cell Carcinoma

• Chon SW
• Jeon SH
• Chang SG

Abstract

PURPOSE: One third of renal cell caricinoma(RCC) patients present with metastatic disease and 20-40% of these patients who undergo nephrectomy for clinically localized RCC will develop metastases. Eventually, the number of those patients who develop metastatic disease will increase to 30-50%. The aim of this study is to compare the efficacy and survival rate in relation to the time of performing metastasectomy and immnuochemotherapy.
MATERIALS AND METHODS
We retrospectively enrolled 12 patients who had undergone radical nephrectomy, immunochemotherapy and metastasectomy between 1998 and 2007. The patients were subdivided into two groups. Group 1 included the patients who received radical nephrectomy, metastasectomy and immunochemotherapy altogether. Group 2 included the patients who developed metachronous metastases during follow-up after radical nephrectomy and so they then underwent metastasectomy and immunochemotherapy. We compared the survival rates between the two groups.
RESULTS
The sites of initial metastasis were found to be 8 cases of lung metastasis, 2 of bone metastasis, 1 of brain metastasis and 1 of colon metastasis. The 5-year survival rate of the 5 patients from group 1 was 37.5%. In group 2, the 5-year survival rate of the 7 patients was 71.4% and the disease-free mean interval between primary resection of the kidney and metastasectomy was 36.43+/-7.62 months. Statistically, there was no significant difference of survival rates between the two groups.
CONCLUSIONS
The results of this study suggest that metastasectomy followed by radical nephrectomy results in a longer survival time for the patients with metastatic cancer than that of patient that undergo radical nephretomy, metastasectomy and immunotherapy at the same time. We can recommend metastasetomy any time for the RCC patients who have technical resectable metastases with possibly positive prognostic factors and a good functional condition.

Keyword

Renal cell carcinoma; Metastasis; Immunotherapy

MeSH Terms

Brain
Carcinoma, Renal Cell
Colon
Follow-Up Studies
Humans
Immunotherapy
Kidney
Lung
Metastasectomy
Neoplasm Metastasis
Nephrectomy
Retrospective Studies
Survival Rate

Figure

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  Fig. 1 Comparison of the cumulative survival. The survival rate of group 2 was calculated from the time of radical nephrectomy. There was no significant difference in the survival rates of the 2 groups (p=0.447 by Kaplan Meier analysis and the log rank test).

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  Fig. 2 Comparison of the cumulative survival. The survival rate of group 2 was calculated from the time of metastasectomy. There was no significant difference in the survival rates of the 2 groups (p=0.704, by Kaplan Meier analysis and the log rank test).

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