C52 Prognostic factors and survival of clear cell renal carcinoma patients with bone metastasis

The clinical factors influencing the survival of renal clear cell carcinoma patients with bone metastasis was examined in a retrospective study setting.

We analyzed the data of 65 patients operated between 1990 and 2008. Descriptive statistical method was also utilized, clinical data regarding survival were evaluated with Life table and Kaplan-Meier method, moreover, for multivariable analysis Cox regression method was applied.

Based on Kaplan-Meier curves age, sex, clinical symptoms, pathological fracture, progression to the soft tissues, localization of tumor (spinal metastases are excluded), size of metastasis, whether the occurrence of multiplex metastases is multiorganic or localized in the skeletal system only, and the stage and grade of the primary renal cancer did not influence the survival. The survival was significantly improved if the bone metastases were late onset (occured more than four years after the renal surgery); moreover, it was solitary, Fuhrmann grade 1 and radical surgery was performed. Based on Cox regression analysis, the results indicated that survival after bone surgery was influenced by the multiplicity and grade of metastasis and radicality of the surgery, whereas survival after nephrectomy was significantly influenced by the time of onset and grade of metastasis. As for the patients surviving bone surgery more than five years, there were more patients who had solitary, grade 1 metastases operated on by radical surgery than in the group where patients died earlier than five years. When the solitary metastasis was radically removed, 75.0% of the patients survived the first, 61.6% the second, 51.3% the third, 39.9% the fourth, 35.5% the fifth postoperative years. If the metastasis was multiple or the surgery was not radical, the 40.9% of patients survived the first, 16.0 % the second, 6.8% the third, 3.4% the fourth and none of the patients survived the fifth year.

According to our results we can conclude that in case of multiple or surgically unremovable metastases, minimal invasive surgery is much preferred. Moreover, in the case of solitary, low grade, operable metastases especially when they occur more than four years, we have to go ahead for a radical removal since in this way longer survival time could be expected (more than 10 years in certain cases). According to our best knowledge, the prognostic relevance of Fuhrman grade of bone metastases was not published before.