Partial Nephrectomy in the Setting of Metastatic Renal Cell Carcinoma

• Published in: The Journal of urology Vol. 192; no. 1; pp. 36 - 42
• Main Authors: Babaian, Kara N, Merrill, Megan M, Matin, Surena, Tamboli, Pheroze, Tannir, Nizar M, Jonasch, Eric, Wood, Christopher G, Karam, Jose A
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2014; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; carcinoma; Carcinoma, Renal Cell - secondary; Carcinoma, Renal Cell - surgery; diagnosis; Female; Humans; kidney; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Kidneys; Male; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); neoplasm metastasis; nephrectomy; Nephrectomy - methods; Nephrology. Urinary tract diseases; renal cell; Retrospective Studies; Tumors; Tumors of the urinary system; Urology; cancer specific survival; estimated glomerular filtration rate; radical nephrectomy; partial nephrectomy; Cr; kidney; renal cell; creatinine; cytoreductive nephrectomy; mRCC; neoplasm metastasis; DOD; overall survival; nephrectomy; no disease evidence; metastatic RCC; eGFR; CSS; OS; diagnosis; CN; dead from disease; NED; renal cell carcinoma; RCC; carcinoma; RN; PN; Kidney disease; Nephrology; Urinary system disease; Carcinoma; Malignant tumor; Metastasis; Kidney; Urology; Treatment; Urinary system; Nephrectomy; Partial; Surgery; Kidney cancer; Grawitz tumor; Advanced stage; Metastatic; Diagnosis; Cancer
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2014.01.086

Purpose Cytoreductive nephrectomy remains the standard of care for appropriately selected patients with metastatic renal cell carcinoma. Although the role of partial nephrectomy is well accepted in patients with localized disease, limited data are available on partial nephrectomy in the metastatic setting. We identified the indications for and outcomes of partial nephrectomy in the setting of metastatic renal cell carcinoma with particular attention to partial nephrectomy subgroups. Materials and Methods We analyzed data on a consecutive cohort of 33 patients with metastatic renal cell carcinoma who underwent partial nephrectomy at a single institution between 1996 and 2011. Nonparametric statistics were used to compare partial nephrectomy subgroups. Overall survival was estimated using the Kaplan-Meier method and survival functions were compared using the log rank test. Results At presentation 8 patients had bilateral synchronous renal masses, 20 had a metachronous contralateral renal mass and 5 had a unilateral renal mass. A total of 22 patients (67%) died of disease a median of 27 months postoperatively. Patients who underwent partial nephrectomy for a metachronous contralateral renal mass and a renal mass 4 cm or less had the best overall survival (61 and 42 months, respectively). Median overall survival in patients with vs without metastatic disease at original diagnosis was 27 vs 63 months (p = 0.003). Conclusions Our findings suggest that metastasis at the original diagnosis and the timing of presentation of the partial nephrectomy index lesion have an important role in survival. These factors should be considered when determining which patients would benefit from partial nephrectomy in the setting of metastatic renal cell carcinoma.