NEW ORLEANS—Two studies presented at the 2015 American Urological Association annual meeting suggest that complete metastasectomy may have a role in improving survival among patients with metastatic renal cell carcinoma (mRCC).
In a retrospective study of 119 patients who underwent radical nephrectomy and were diagnosed with metastatic disease, Japanese researchers found that the 55 patients treated with metastasectomy had a significantly better 5-year overall survival rate compared with the 64 patients who did not (68% vs. 27%).
Of the 119 patients, 48 (40%) had lung-only metastases and 71 (60%) had metastases at sites other than the lung. For both groups, the overall 5-year survival rate was significantly better among those who underwent metastasectomy than those who did not (82.3% vs. 51.4% for those with lung-only metastases and 57.4% vs. 71.% for those with non-lung-only metastases).
Of the 55 patients who underwent metastasectomy, 9 (16%) had incomplete metastasectomy whereby all lesions were not resected. The estimated 5-year cancer-specific survival rate of these patients was lower than those who had complete resection (68.6% vs. 78.2%), but higher than patients who did not undergo metastasectomy (28.5%), the researchers reported.
In multivariate analysis, complete metastasectomy was independently associated with a significant 69% decreased risk of death.
In the other study, South Korean investigators reviewed the medical records of 323 mRCC patients who received no systemic treatment. Of these, 13 underwent complete metastasectomy followed by targeted therapy, 48 underwent partial metastasectomy followed by targeted therapy, and 262 received targeted therapy only. The median overall survival was 70.9, 29.9, and 19.4 months in the complete, partial, and non-metastasectomy groups, respectively. On multivariate analysis, complete metastasectomy was associated with a significant 70% decreased risk of death.
The investigators concluded that aggressive metastasectomy should be considered in mRCC patients if the metastases are surgically resectable.