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Survival after complete surgical resection of multiple metastases from renal cell carcinoma.

Abstract Although a role for resection of solitary metastases from renal cell carcinoma (RCC) has been described, the utility of surgery in patients with multiple sites of disease has been less well defined. The authors report the survival of patients who underwent complete metastasectomy for multiple RCC metastases.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title cancer
Publication Year Start




PMID- 21692048
OWN - NLM
STAT- MEDLINE
DCOM- 20110823
LR  - 20110621
IS  - 1097-0142 (Electronic)
IS  - 0008-543X (Linking)
VI  - 117
IP  - 13
DP  - 2011 Jul 1
TI  - Survival after complete surgical resection of multiple metastases from renal cell
      carcinoma.
PG  - 2873-82
LID - 10.1002/cncr.25836 [doi]
AB  - BACKGROUND: Although a role for resection of solitary metastases from renal cell 
      carcinoma (RCC) has been described, the utility of surgery in patients with
      multiple sites of disease has been less well defined. The authors report the
      survival of patients who underwent complete metastasectomy for multiple RCC
      metastases. METHODS: The authors identified 887 patients who underwent
      nephrectomy for RCC between 1976 and 2006 who developed multiple metastatic
      lesions. The impact of complete metastasectomy on survival was evaluated
      controlling for the timing, location, and number of metastases and for patient
      performance status. RESULTS: Of 887 patients, 125 (14%) underwent complete
      surgical resection of all metastases. Complete metastasectomy was associated with
      a significant prolongation of median cancer-specific survival (CSS) (4.8 years vs
      1.3 years; P < .001). Patients who had lung-only metastases had a 5-year CSS rate
      of 73.6% with complete resection versus 19% without complete resection (P <
      .001). A survival advantage from complete metastasectomy also was observed among 
      patients with multiple, nonlung-only metastases, who had a 5-year CSS rate of
      32.5% with complete resection versus 12.4% without complete resection (P < .001).
      Complete resection remained predictive of improved CSS for patients who had >/= 3
      metastatic lesions (P < .001) and for patients who had synchronous (P < .001) and
      asynchronous (P = .002) multiple metastases. Moreover, on multivariate analysis, 
      the absence of complete metastasectomy was associated significantly with an
      increased risk of death from RCC (hazard ratio, 2.91; 95% confidence interval,
      2.17-3.90; P < .001). CONCLUSIONS: The current results indicated that complete
      resection of multiple RCC metastases may be associated with long-term survival
      and should be considered when technically feasible in appropriate surgical
      candidates.
CI  - Copyright (c) 2011 American Cancer Society.
FAU - Alt, Angela L
AU  - Alt AL
AD  - Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota,
      USA.
FAU - Boorjian, Stephen A
AU  - Boorjian SA
FAU - Lohse, Christine M
AU  - Lohse CM
FAU - Costello, Brian A
AU  - Costello BA
FAU - Leibovich, Bradley C
AU  - Leibovich BC
FAU - Blute, Michael L
AU  - Blute ML
LA  - eng
PT  - Journal Article
DEP - 20110110
PL  - United States
TA  - Cancer
JT  - Cancer
JID - 0374236
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Bone Neoplasms/mortality/*secondary/surgery
MH  - Carcinoma, Renal Cell/mortality/pathology/*secondary/*surgery
MH  - Humans
MH  - Kidney Neoplasms/mortality/*pathology/surgery
MH  - Lung Neoplasms/mortality/*secondary/surgery
MH  - Male
MH  - Middle Aged
MH  - Nephrectomy
MH  - Prognosis
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2011/06/22 06:00
MHDA- 2011/08/24 06:00
CRDT- 2011/06/22 06:00
PHST- 2010/08/24 00:00 [received]
PHST- 2010/11/12 00:00 [revised]
PHST- 2010/11/12 00:00 [accepted]
PHST- 2011/06/22 06:00 [entrez]
PHST- 2011/06/22 06:00 [pubmed]
PHST- 2011/08/24 06:00 [medline]
AID - 10.1002/cncr.25836 [doi]
PST - ppublish
SO  - Cancer. 2011 Jul 1;117(13):2873-82. doi: 10.1002/cncr.25836. Epub 2011 Jan 10.