Unusual Metastases in Renal Cell Carcinoma: A Single Institution Experience and Review of Literature

Abstract

Background: To report location and management of atypical metastases from renal cell carcinoma (RCC) in the INCMNSZ.

Methods: Between 1987 to 2009, 545 patients with RCC were retrospectively identified at the INCMNSZ in Mexico City. Patients with unusual metastases confirmed by histopathology were analyzed. Epidemiological, clinical, diagnosis, treatment and outcome data were reviewed.

Results: Sixty patients developed 98 unusual metastases secondary to RCC. The group was comprised of 35 men (58.3%), with a mean age of 60 years at diagnosis. Metachronous unusual metastases with primary renal cancer were observed in 37 individuals (61.7%). Median time from primary RCC diagnosis to the first unusual metastasis was 16.5 months. Median survival from diagnosis of the first unusual metastasis to death was 5.0 months (CI 95%: 2.8-7.2 months). Patients with initial solitary metastatic lesion in an unusual site (28.3%) had a better survival compared to patients who primarily presented with multiple metastases, 17.0 (CI 95%: 6.1-27.9) Vs 3.0 months (CI 95%: 0.9-5.1), p = 0.001. Unusual metastasis resection (21 patients) improved survival, 25.0 (CI 95%: 5.1-44.9) Vs 3.0 months (CI 95%: 0.8-5.2), p < 0.0001. No survival difference was observed between localization of unsual metastases (p = 0.72).

Conclusions: In patients with advanced RCC we suggest an individual diagnostic and surgical approach with optimal resection strategy which achieves adequate disease-free resection margins and maximal tissue preservation, even in the presence of unusual metastatic sites, multifocality, or history of metastasectomy, both for palliation of symptoms and because it provides the opportunity for meaningful disease free and overall survival.




World J Oncol. 2010;1(4):149-157
doi: https://doi.org/10.4021/wjon232w