Pattern of metastases in renal cell carcinoma: A single institution study

Abstract

Background: Increasing numbers of patients with renal cell carcinoma
\n(RCC) are incidentally detected and can be potentially cured by surgery
\nalone. In treating metastatic RCC, worthwhile survival rates are
\nachieved in cases of low burden recurrences. This necessitates a
\nrational follow up protocol, which picks up early recurrences and
\navoids costly surveillance for those with a favorable prognosis. Aims:
\nWe studied the patterns of metastases occurring in patients operated
\nfor localized or locally advanced renal cell carcinoma in the Indian
\nsetting and try to evolve a suitable follow up protocol. Setting and
\nDesign: Institution based, retrospective data.\tMethod and Materials:
\nRecords of patients from January 1988 to December 2003, operated for
\ninitially localized RCC were reviewed. Follow up was performed using an
\nestablished protocol. Occurrence of metastases and their patterns were
\nstudied. Statistical analysis used: Comparison of the different
\nsurvival times was performed using the one-way analysis method.
\nMultiple comparisons (post hoc test) were performed using the
\nBonferroni method. Result: Follow up was available on 209 patients.
\nMean survival was 43.75 months (SD ± 28.72). Thirty-nine patients
\ndeveloped 59 metastases. Lungs were the commonest site of metastases
\n(37%), followed by bone (22%), liver (19%) and brain (8%). Relapse and
\nsurvival showed significant correlation with pathological stage (p <
\n0.001), with higher stage being associated with greater relapses and
\nlesser survival. There was no correlation between site of recurrence
\nand stage of disease. Conclusions: Occurrence of metastases correlate
\nwith the pathological stage of the disease at primary presentation.
\nTailored, stage-based follow up protocols allow adequate surveillance
\nfor disease activity and progression without escalating the overall
\ncosts.