Patient Survival After Surgery for Osseous Metastases from Renal Cell Carcinoma

Lin, Patrick P.; Mirza, Attiqa N.; Lewis, Valerae O.; Cannon, Christopher P.; Shi-Ming Tu; Tannir, Nizar M.; Yasko, Alan W.
August 2007
Journal of Bone & Joint Surgery, American Volume;Aug2007, Vol. 89-A Issue 8, p1794
Academic Journal
Background: Skeletal metastases from renal cell carcinoma are highly destructive vascular lesions. They pose unique surgical challenges due to the risk of life-threatening hemorrhage and resistance to other treatments. The goal of this retrospective study was to evaluate factors that may affect survival after surgical treatment of metastases of renal cell carcinoma. Methods: We performed a retrospective review of a series of 295 consecutive patients who had been treated for metastatic renal cell carcinoma at one institution between 1974 and 2004. There were 226 men and sixty-nine women. A total of 368 metastases of renal cell tumors to the extremities and pelvis were treated. The surgical procedures included curettage with cementing and/or internal fixation (214 tumors), en bloc resection (117), closed nailing (twenty-seven), amputation (four), and other measures (six). Overall survival was calculated with Kaplan-Meier analysis. The log-rank test was used to evaluate the effect of different variables on overall survival. Results: The overall patient survival rates at one and five years were 47% and 11%, respectively. The metastatic pattern had a significant effect on the survival rate (p < 0.0001): patients with a solitary bone metastasis had the most favorable overall survival rate. Patients with multiple bone-only metastases had a better survival rate than patients with pulmonary metastases (p = 0.009). A clear-cell histological subtype was also associated with better survival (p < 0.0001). The tumor grade did not predict survival (p = 0.17). Fifteen patients (5%) died within four weeks after surgery. The causes included acute pulmonary failure (seven patients), multiorgan failure (six), cerebrovascular accident (one), and hypercalcemia (one). There were no deaths attributable to intraoperative hemorrhage. Discussion: Survival beyond twelve months is possible for a substantial proportion of patients with metastatic renal cell carcinoma. Patients with a clear-cell histological subtype, bone-only metastases, and a solitary metastasis have superior survival rates. The presence of pulmonary metastases does not predict early death in a reliable manner, and some patients may survive for years with pulmonary and systemic disease. The data are important for surgeons to consider when choosing treatment for these patients. For example, local control of disease and implant stability are important issues for patients with a potential for a long duration of survival. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Behandlungsstrategien bei Skelettmetastasen. Leithner, A.; Friesenbichler, J.; Andreou, D.; Maurer-Ertl, W.; Tunn, P.U. // Der Orthopäde;Oct2012, Vol. 41 Issue 10, p863 

    The primary goals of multimodal, interdisciplinary treatment of bone metastases are to achieve mobility, pain relief, and improve quality of life. In cooperation with radiotherapists and oncologists, an individual therapy plan has to be designed. As bone metastases are a sign of a systemic...

  • Multilocular cystic renal cell carcinoma: an experience of clinical management for 31 cases. Kan Gong; Ning Zhang; Zhisong He; Liqun Zhou; Guiting Lin; Yanqun Na // Journal of Cancer Research & Clinical Oncology;Apr2008, Vol. 134 Issue 4, p433 

    In order to increase our knowledge and understanding about multilocular cystic renal cell carcinoma (MCRCC), including diagnosis, surgical management, pathologic and prognostic characteristics, clinical data of patients who suffered with MCRCC were reviewed retrospectively. From 1998 to 2005,...

  • Multidisciplinary treatment including sorafenib stabilized the bone metastases of renal cell carcinoma in an immunosuppressed renal transplant recipient. Hasegawa, Yasuhisa; Mita, Koji; Matsubara, Akio; Ohdan, Hideki // International Journal of Clinical Oncology;Oct2009, Vol. 14 Issue 5, p465 

    We report a case of metastatic renal cell carcinoma in the native kidney of a renal transplant recipient. The patient was a 57-year-old man in whom a tumor in the native kidney and bone metastasis were found incidentally on imaging, 10 years after cadaveric renal transplantation....

  • Stereotactic body radiation therapy for melanoma and renal cell carcinoma: impact of single fraction equivalent dose on local control. Stinauer, Michelle A.; Kavanagh, Brian D.; Schefter, Tracey E.; Gonzalez, Rene; Flaig, Thomas; Lewis, Karl; Robinson, William; Chidel, Mark; Glode, Michael; Raben, David // Radiation Oncology;2011, Vol. 6 Issue 1, p34 

    Background: Melanoma and renal cell carcinoma (RCC) are traditionally considered less radioresponsive than other histologies. Whereas stereotactic body radiation therapy (SBRT) involves radiation dose intensification via escalation, we hypothesize SBRT might result in similar high local control...

  • Microvessel density is high in clear-cell renal cell carcinomas of Ukrainian patients exposed to chronic persistent low-dose ionizing radiation after the Chernobyl accident. Romanenko, A.; Ruiz-Saurí, A.; Morell-Quadreny, L.; Valencia, G.; Vozianov, A.; Llombart-Bosch, A. // Virchows Archiv;Jun2012, Vol. 460 Issue 6, p611 

    During the 25-year period subsequent to the Chernobyl accident, the morbidity of malignant renal tumors in Ukraine has increased from 4.7 to 10.7 per 100,000 of the total population. Recent studies of our group have shown that increases in morbidity, aggressiveness, and proliferative activity of...

  • 111: Platelet count in renal cell carcinoma, does it has prognostic significance? G., Ravi Sankar; P., Vedamurthy Reddy; S., Subramanian // Indian Journal of Urology;Supplement2, Vol. 24, pS87 

    Introduction: We correlated platelet count to renal cell carcinoma characteristics, and evaluated the potential prognostic value of thrombocytosis in localized and metastatic tumours. Methods: A total of 30 patients operated on for a renal cell carcinoma in our department from 2002 to 2007 were...

  • Rapid Improvement in Pain and Functional Level in a Patient with Metastatic Renal Cell Carcinoma: A Case Report and Review of the Literature. Hird, Amanda E.; Chow, Edward; Ehrlich, Lisa; Probyn, Linda; Sinclair, Emily; Yip, Darwin; Ko, Yoo-Joung // Journal of Palliative Medicine;Oct2008, Vol. 11 Issue 8, p1156 

    Renal cell carcinoma (RCC) represents approximately 3% of all adult cancers and is more common in males. Systemic treatment for RCC has improved following the introduction of sunitinib. Bone metastases are present in up to 50% of RCC patients. We report a case of rapid improvement in metastatic...

  • Impact of tumor size on the long-term survival of patients with early stage renal cell cancer. Kuczyk, M.; Wegener, G.; Merseburger, A.; Anastasiadis, A.; Machtens, S.; Zumbrägel, A.; Hartmann, J.; Bokemeyer, C.; Jonas, Udo; Stenzl, A. // World Journal of Urology;Jan2005, Vol. 23 Issue 1, p50 

    As the biological behaviour of even early stage renal cell cancer (RCC) strongly correlates with tumor size, it has been argued that the inclusion of RCC up to a maximum diameter of 7 cm into a common subgroup classified as T1 according to the 5th edition of the TNM system would not adequately...

  • The role of embolization in the management of tumour recurrence after radical nephrectomy. Akhtar, Kashif; Lee, George; Khan, Masood; Mitchell, Adam; Livni, Naomi; Christmas, Timothy // British Journal of Hospital Medicine (17508460);Jan2010, Vol. 71 Issue 1, p52 

    The article discusses the case of a 56-year-old woman who developed a tumour following radical nephrectomy. Her tomography scan at three months revealed bilateral small pulmonary metastases with no evidence of renal bed recurrence and her bone scan was also negative. The article also discusses...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics