Introduction & Objectives
Complete metastasectomy in patients with potentially surgically resectable metastases have an important role in the management of metastatic renal cell carcinoma (mRCC). Clinical benefits of incomplete or Partial Metastasectomy (PME) can be assessed in the era of targeted therapy. The aim of present retrospective study was to evaluate the preliminary efficacy of PME and following targeted therapy.
Material & Methods
Data was collected from single center for patients with clear cell mRCC and metastases at presentation treated surgically with following therapy or medical treatment alone from 2008-2015. Resection of metastases was incomplete (patients had at least 1 but not all metastases resected). All patients had prior nephrectomy. Kaplan Meier analysis was used to estimate Progression-Free (PFS) and Overall (OS) survival.
Median follow-up was 31.2 months (3–82). In total, 47 of 147 patients (32.0%) received PME with systemic therapy, and 100 (68.0%) patients were treated with systemic therapy alone. These treatments included sunitinib (n=53), bevacizumab+IFN (n=11), pazopanib (n=21), sorafenib (n=73), axitinib (n=11), everolimus (n=22), and immunotherapy (n=56). 80 (54.4%) patients received more than 2 treatment lines. Most common metastatic sites were lungs (70%) and bones (28%). MSKCC, Age and Rare metastatic sites were significant prognosic predictors od Survival and PFS (р<0.01) but did not differed between patients who did and did not undergo PME (P>0.05). OS rate was higher in group of combined treatment (PME+ST) compare to Systemic Treatment (ST): 32 and 29 months, respectively (р=0.08). There was associated with a trend of improvement in survival in patients who underwent treatment of PME and ST sequentially, then it was provided concurrently, with OS of 46 months (95% CI1,67 (0,8 – 3,1) compared with 31 months (95% CI 0.59 (0,3-1,1)) in favour of sequential scheme (P=0.09). Also, PME significantly increased PFS in first-line therapy (P=0.018), and did not cause a significant impact on PFS in second- or third- lines (P>0.1).
The current results supposed that partial metastasectomy of RCC lesions may be associated with increased efficacy of first-line targeted therapy and long-term survival of selected mRCC patients. Prospective trials are needed to better establish the role of iME in this group of patients.