Patients who have renal cell carcinoma (RCC) and solitary bone metastasis with no concomitant metastases may experience improved survival from bone surgery, according to study findings presented at the 2017 Genitourinary Cancers Symposium in Orlando, Florida.
In a study of 300 patients with metastatic RCC, bone was the only metastatic site in 64 patients (21%), and 22 of them (7%) had a synchronous solitary bone metastasis (SSBM), defined as a single bone metastasis without concomitant visceral lesions at the initial diagnosis of RCC, as Fiorella Ruatta, MD, of IRCCS Candiolo (Turin), Italy, and colleagues reported in a poster presentation. The remaining 236 patients (79%) had concomitant metastases at other sites.
The median time from diagnosis to bone metastases was 32 months; the median overall survival (OS) from diagnosis of bone metastases was 23 months. OS decreased with an increasing number of bone metastases. Patients with 1, 2–5, and more than 5 bone metastases had a median OS of 28, 18, and 9 months, respectively. Bone metastases in the presence of concomitant metastases were associated with significantly shorter OS (18 vs 46 months). Patients with SSBM had significantly better OS than those with concomitant metastases at other sites (40 vs 20 months).
Patients in good, intermediate, and poor risk groups as determined by Memorial Sloan Kettering Cancer Center (MSKCC) score had a median OS of 43, 22, and 7 months, respectively.
In multivariate analysis, concomitant metastases remained a predictor of poor prognosis, whereas good MSKCC, radical resection, and SSBM predicted better OS.
Patients with SSBM had a significant 44% lower risk of death compared with those who did not have SSBM. In patients with bone metastases, those who underwent radical resections had a significant 32% lower risk of death than those who did not.
The investigators concluded that, in the presence of solitary bone metastasis without concomitant metastases at the initial diagnosis of RCC, bone surgery or other curative local therapy should be considered to achieve local tumor control and increase survival.
The study is the largest single-institution experience evaluating prognosis in patients with bone metastases from RCC.
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1. Ruatta F, Derosa L, Albiges L, et al. Prognosis of renal cell carcinoma with bone metastases: experience in 300 consecutive patients. Poster presented at the 2017 Genitourinary Cancers Symposium in Orlando, Florida. Poster Session C, Board E2. Abstract 463.