Metastasectomy in patients with multiple and oligometastases of renal cell carcinoma treated in general clinical practice

Aim. To determine the impact of metastasectomy on overall survival in patients with metastatic renal cell carcinoma and to identify prognostic factors for this cytoreductive intervention.

Materials and methods. We retrospectively analyzed the database of 226 patients who underwent metastasectomy at the Moscow City Oncological Hospital No. 62 and the City Clinical Oncological Dispensary (Saint Petersburg) between 2006 and 2022. Solitary and single metastases were detected in 103 (45.6 %), and multiple metastases – in 123 (54.5 %) patients. In patients with solitary and single metastases synchronous and metachronous metastases were detected in 20 (19.4 %) and 83 (80.6 %) patients, with multiple metastases – in 51 (41.5 %) and 72 (58.5 %) patients respectively. Complete metastasectomy was performed in 70 (68 %) patients with solitary, single metastases and in 36 (29.3 %) patients with multiple metastases. Patients with solitary and single metastases after complete metastasectomy did not receive systemic therapy until tumor progression. Before the start of drug therapy metastasectomy was performed in 63 (61.2 %) patients with solitary and single metastases, in case of multiple metastases in 17 (13.8 %) patients. Patients’ survival rates were evaluated using the Survival Analysis mathematical and statistical method with calculation of descriptive characteristics in the form of a life table and construction of Kaplan–Meier curves.

Results. The univariate analysis in patients with multiple and oligometastases of renal cancer revealed that IMDC (International Metastatic RCC Database Consortium) prognosis, tumor differentiation degree per Fuhrman, ECOG (Eastern Cooperative Oncology Group) status, complete metastasectomy and metastasectomy after the start of systemic therapy had negative impact on survival rates. Multivariate analysis in patients with oligometastases of renal cancer revealed that IMDC prognosis, type of metastases, brain metastases, complete metastasectomy and metastasectomy after the start of systemic therapy had negative impact on survival rates, while in patients with multiple RCC metastases only complete metastasectomy and metastasectomy after the start of systemic therapy had negative impact on survival rates.

Conclusion. Our data indicate that metastasectomy is an important component of multimodal treatment of metastatic renal cell carcinoma patients. To better define the indications for this cytoreductive surgery, further studies are needed to identify additional prognostic factors in metastatic renal cell carcinoma patients.

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