Surgery Ups Survival in Cancer Patients with Kidney Metastases

Surgical intervention in select patients with oligometastatic disease and good performance status should be considered, the researchers stated.
Surgical intervention in select patients with oligometastatic disease and good performance status should be considered, the researchers stated.

Patients with non-renal primary cancers that metastasize to the kidneys appear to have better survival if they undergo surgical treatment, new findings suggest.

A team at the University of Texas MD Anderson Cancer Center in Houston led by Jose A. Karam, MD, conducted a retrospective study of 151 patients diagnosed with a primary non-renal malignancy accompanied by renal metastases. Patients had a median age of 56.7 years.

The most common presenting symptoms were flank pain (30%), hematuria (16%), and weight loss (12%). The most common primary tumor site was the lung (43.7% of cases). The median overall survival (OS) from primary tumor diagnosis was 3.08 years, and the median OS from the time of metastatic diagnosis was 1.13 years, Dr. Karam's group reported online ahead of print in BJU International. For surgically-treated patients, median overall survival from primary tumor diagnosis and metastatic diagnosis was 4.81 and 2.24 years, respectively.

“Since renal metastases appear early in the metastatic process and survival appears to be longer in patients treated with surgery, surgical intervention in carefully selected patients with oligometastatic disease and good performance status should be considered,” the authors concluded. “A multidisciplinary approach, with input from urologists, oncologists, radiologists and pathologists, is needed to achieve the optimum outcomes for this specific patient population.”

The authors acknowledged that selection bias could explain the better survival outcomes observed in the surgery patients because “patients undergoing surgery with curative intent are likely to be those with minimal metastatic disease and good performance status.” A difference in systemic therapies used in the surgery patients also could explain the better observed outcomes in this cohort. 

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