Complete resection of kidney mets ups overall survival

SAN FRANCISCO-Patients who undergo resection of all metastatic kidney lesions, especially of disease that has spread to the lungs, appear to have outcomes as good as patients who have only a single surgery, according to a presentation at the 2010 Genitourinary Cancers Symposium.

Overall, about 31% of 125 patients who underwent complete resection of all metastases were alive after 10 years compared with 9% of 257 patients who had incomplete resection of metastases and 2% of 505 patients who did not have any resection of metastases, said researchers from the Mayo Clinic in Rochester, Minn. Those differences achieved statistical significance
(P < .001).

"These results emphasize the importance of considering complete surgical resection of all resectable metastatic lesions in patients with renal cell carcinoma to achieve durable survival," said Angela Alt, MD, a resident in the department of urology at the Mayo Clinic.

In their retrospective study, Dr. Alt and colleagues identified 887 patients treated with radical nephrectomy for renal cell carcinoma between 1976 and 2006 who had multiple metastatic lesions either prior to or following nephrectomy. Most of the patients were treated at the Mayo clinic for their primary operation (abstract 317).

On reviewing data on patients with lung metastases, they found that the 10-year survival rate among those who had all the lung lesions resected was about 50%, compared with about 10% of those patients who had incomplete surgical resection (P < .001).

"We believe the better survival we see in the patients who undergo complete resection has to do with the decrease of tumor burden," Dr. Alt said, adding that "surgical resection of all metastases should be considered if technically feasible prior to patient randomization in systemic therapy trials.

"It will be important to determine which features are important in selecting patients for complete surgical resection," she said.

Commentary

Commenting on the study was E. Jason Abel, MD, a fellow in urologic oncology at Houston's M.D. Anderson Cancer Center.

"It is difficult to know whether the association of improved survival with complete resection of metastatic disease is a cause and effect relationship based on a retrospective study," Dr. Abel said.

"It is likely that patients chosen for surgery are healthier and have a smaller volume of disease in a more favorable location compared to the average patient with metastatic renal cell carcinoma," he suggested.

Dr. Abel added that it would be interesting to see how the role of surgery for metastatic disease evolved with the improvement of systemic therapy.

The role of surgery may expand in patients with minimal metastatic disease who have had significant response in their metastatic lesions, he said.