Gene signatures of pulmonary metastases of renal cell carcinoma reflect the disease-free interval and the number of metastases per patient

541 Background: Late relapse of renal cell carcinoma (RCC), or presentation with metastatic disease after a disease free interval of >5 years, is a known behavior of RCC. Recent studies have concluded that late relapse RCC is associated with favorable patient and tumor characteristics as well as an improved response to targeted therapy (TT) when compared to early relapse patients. Less studied are patients who relapse very late, with a disease free interval >10 years. We evaluated the clinical characteristics, response to TT and outcomes of this unique population. Methods: We collected data on consecutive patients with metastatic RCC who had disease recurrence >10 years after nephrectomy. Outcomes were tabulated using basic statistical techniques; adverse events were graded using CTCAE v4.0 and treatment response graded using RECIST 1.1. Results: Among 720 RCC patients treated with nephrectomy, we identified 8 who developed recurrent metastatic disease after a >10 year disease free interval (median: 16.7 years; range: 11.7-29.0). All patients presented with clear cell histology; 88% favorable IMDC and MSKCC risk subgroups. All patients presented with multiple metastases, with the most common sites being lung and bone, while unusual sites such as soft tissue, pancreas and adrenal were also detected. Median time on first-line TT was 20.1 months; 4, 3 and 1 patient received pazopanib (best response: PR), sunitinib (best response: SD) and cytokine (best response: PD) as first-line therapy, respectively. The median number of sequential TT received was 2 (range: 1-4). Four patients died, median OS was 46.6 months (range: 9.8-129), 3 year OS rate was 63%. Common adverse events to TT were fatigue (88%), anorexia (38%) and diarrhea (50%), 94% grade 1/2. Conclusions: Patients are at life-long risk of recurrence after resection of localized RCC as it is possible for metastases to present >10 years after resection. Patients in our study had relatively large metastatic burden and a wide distribution of metastatic sites, insights that may be useful clinically during surveillance. Our cohort demonstrated favorable prognostic features and outcomes when compared to historical controls.

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Metastatic Renal Cell Carcinoma Mimicking a Meningioma

Neurosurgery ◽

10.1227/00006123-198310000-00015 ◽

1983 ◽

Vol 13 (4) ◽

pp. 430-434 ◽

Cited By ~ 21

Author(s):

K. Killebrew ◽

M. Krigman ◽

M. S. Mahaley ◽

J. H. Scatliff

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Primary Tumor ◽

Renal Cell ◽

Term Survival ◽

Disease Free Interval ◽

Free Interval ◽

Solitary Metastases ◽

Disease Free

Abstract We report a patient with renal cell carcinoma metastatic to the left trigone, which mimicked an intraventricular meningioma. The metastasis was recognized 13 years after removal of the primary tumor, a longer disease-free interval than any previously reported cases with brain metastases of renal cell carcinoma. The patient is now free of disease 4 years after resection and 17 years after the discovery of the primary tumor. Metastatic disease should be considered in all patients with prior resection of renal cell carcinoma who experience the onset of neurological disease, even after a prolonged disease-free interval. Long term survival is observed after the resection of solitary metastases, particularly if these appear after a prolonged disease-free interval.

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The Significance of Metastasectomy in Patients with Metastatic Renal Cell Carcinoma in the Era of Targeted Therapy

BioMed Research International ◽

10.1155/2015/176373 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 15

Author(s):

Xiaoteng Yu ◽

Bing Wang ◽

Xuesong Li ◽

Gang Lin ◽

Cuijian Zhang ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Overall Survival ◽

Prognostic Factors ◽

Targeted Therapy ◽

Renal Cell ◽

Complete Resection ◽

Disease Free Interval ◽

Free Interval ◽

Metastatic Sites ◽

Disease Free

Objective. To investigate the efficacy of surgery in the treatment of metastatic renal cell carcinoma (mRCC) and to identify prognostic factors. Methods. A single center retrospective study of 96 patients with mRCC from December 2004 to August 2013. Results. The median follow-up time was 45 months. Thirty-one (32.3%) of the patients received complete resection of metastatic sites, 11 (11.5%) of the patients underwent incomplete resection of metastatic sites, and 54 (56.3%) of the patients received no surgery. In the univariate Kaplan-Meier analysis, the median overall survival times of the three groups were 52 months, 16 months, and 22 months, respectively (p<0.001). The difference in the overall survival time was statistically significant between complete resection and no surgery groups (HR = 0.43, p=0.009), while there was no significant difference between the incomplete metastasectomy and no surgery groups (HR = 1.80, p=0.102). According to the multivariate Cox regression analysis, complete metastasectomy (HR = 0.49, p=0.033), T stage > 3 (HR = 1.88, p=0.015), disease free interval <12 months (HR = 2.34, p=0.003), and multiorgan involvement (HR = 2.00, p=0.011) were significant prognostic factors. Conclusion. In the era of targeted therapy, complete metastasectomy can improve overall survival. Complete metastasectomy, T stage > 3, disease free interval <12 months, and multiorgan involvement are independent prognostic factors.

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1027 GENE SIGNATURES OF PULMONARY RENAL CELL CARCINOMA (RCC) METASTASES REFLECT METASTASES-FREE INTERVAL AND NUMBER OF METASTASES OF THE PATIENT

European Urology Supplements ◽

10.1016/s1569-9056(09)61011-3 ◽

2009 ◽

Vol 8 (4) ◽

pp. 377

Author(s):

D. Wuttig ◽

M. Meinhardt ◽

B. Baier ◽

S. Fuessel ◽

C. Hoefling ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Gene Signatures ◽

Free Interval

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GENE SIGNATURES PREDICT METASTASES-FREE INTERVAL AND METASTASES NUMBER IN PULMONARY RENAL CELL CARCINOMA (RCC) METASTASES

The Journal of Urology ◽

10.1016/s0022-5347(08)60391-2 ◽

2008 ◽

Vol 179 (4S) ◽

pp. 136-136

Author(s):

Daniela Wuttig ◽

Matthias Meinhardt ◽

Stefan Zastrow ◽

Barbara Baier ◽

Susanne Fuessel ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Gene Signatures ◽

Free Interval

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Tumour Evolution and Seed and Soil Mechanism in Pancreatic Metastases of Renal Cell Carcinoma

Cancers ◽

10.3390/cancers13061342 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1342

Author(s):

Franz Sellner ◽

Sabine Thalhammer ◽

Martin Klimpfinger

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Metastatic Renal Cell Carcinoma ◽

Renal Cell ◽

Clinical Manifestations ◽

Tumour Volume ◽

Disease Free Interval ◽

Pancreatic Metastases ◽

Organ Site ◽

Disease Free

In metastatic renal cell carcinoma, pancreatic metastases can appear in two clinical manifestations: (a) very rarely as isolated pancreatic metastases and (b) in the context with multi-organ metastatic disease. Both courses are characterised by rare, unusual clinical features. For isolated pancreatic metastases, the literature shows no effect on survival in all 11 publications that examined the effect of singular versus multiple pancreatic metastases; a lack of effect on survival time was also present in all 8 studies on pancreatic metastases size, in 7 of 8 studies on the influence of disease-free interval (DFI), and in 6 of 7 studies on the influence of synchronous versus metachronous metastases. In multi-organ site metastases observations, on the other hand, all five available references showed significantly better results in patients with concurrent pancreatic metastases compared to those without pancreatic metastases, although the total number of affected organs in the pancreatic metastases cohort was larger. Tumour volume-dependent risk factors thus remain surprisingly ineffective in both groups, which contradicts the usual behaviour of solid tumours. The reasons for this unusual behaviour and possible relations to tumour evolution and the hypothesis of an influence of a seed and soil mechanism in the occurrence of pancreatic metastases in metastatic renal cell carcinoma are discussed.

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