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Histology is a Prognostic Indicator After Pulmonary Metastasectomy from Renal Cell Carcinoma

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Abstract

Objectives

There are only a few detailed reports concerning the prognosticators following surgical resection of pulmonary metastases (PMs) from renal cell carcinoma (RCC). We investigated the prognosis of patients with RCC PMs undergoing pulmonary metastasectomy and identified prognostic factors in a multi-institutional retrospective study.

Methods

We retrospectively evaluated 84 patients who underwent resection of PMs from RCC between 1993 and 2014. We assessed the clinicopathological characteristics, focusing on the histological findings of PMs. We classified the histology into three types: pure clear cell carcinoma (N = 68), clear cell carcinoma combined with other histology type (N = 8), and non-clear cell carcinoma (N = 8). We examined the relationship between these histological types and the prognosis of patients with PMs from RCC.

Results

Complete resection was achieved in 78 patients (93%). The 5-year overall survival rate after metastasectomy was 59.7%. In multivariate analysis, three factors were found to be independent favorable prognostic factors of overall survival after lung metastasectomy [tumor size <2 cm, hazard ratio (HR) = 0.31, 95% confidence interval (CI) 0.13–0.78, P = 0.012; clear cell type, HR = 0.37, 95% CI 0.16–0.83, P = 0.025; and complete resection, HR = 0.27, 95% CI 0.10–0.78, P = 0.015].

Conclusions

This study indicates that a histological finding of the clear cell type is a significant favorable prognostic factor in addition to complete resection and a tumor size <2 cm. Histological evaluation of PM lesions is important for predicting survival after metastasectomy.

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Abbreviations

CI:

Confidence interval

DFI:

Disease-free interval

HR:

Hazard ratio

ND:

Nodal dissection

OS:

Overall survival

PM:

Pulmonary metastasis

RCC:

Renal cell carcinoma

RFS:

Recurrence-free survival

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Acknowledgements

The authors thank Dr. Jun Atsumi, Dr. Misaki Iijima, Dr. Yoko Azuma, Dr. Toshiki Yajima, and Ms. Kaori Takeshita for their support in data collection.

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Authors and Affiliations

  1. Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan

    Yoichi Ohtaki, Kimihiro Shimizu, Seshiru Nakazawa, Toshiteru Nagashima, Kai Obayashi, Akira Mogi & Hiroyuki Kuwano

  2. Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan

    Yoichi Ohtaki, Kimihiro Shimizu, Seshiru Nakazawa, Toshiteru Nagashima & Kai Obayashi

  3. Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan

    Keiju Aokage, Junji Yoshida, Tomoyuki Hishida & Masahiro Tsuboi

  4. Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Masayuki Nakao, Shohei Mori, Mingyon Mun & Sakae Okumura

  5. Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan

    Mitsuhiro Kamiyoshihara & Hitoshi Igai

  6. Department of General Thoracic Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan

    Masayuki Sugano

  7. Department of General Thoracic Surgery, Teikyo University School of Medicine, Tokyo, Japan

    Yusuke Takahashi & Noriyuki Matsutani

Authors
  1. Yoichi Ohtaki
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  2. Kimihiro Shimizu
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  3. Keiju Aokage
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  4. Masayuki Nakao
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  5. Junji Yoshida
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  6. Mitsuhiro Kamiyoshihara
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  7. Masayuki Sugano
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  8. Yusuke Takahashi
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  9. Seshiru Nakazawa
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  10. Toshiteru Nagashima
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  11. Kai Obayashi
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  12. Tomoyuki Hishida
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  13. Masahiro Tsuboi
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  14. Shohei Mori
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  15. Mingyon Mun
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  16. Sakae Okumura
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  17. Hitoshi Igai
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  18. Noriyuki Matsutani
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  19. Akira Mogi
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  20. Hiroyuki Kuwano
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Corresponding author

Correspondence to Kimihiro Shimizu.

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Conflict of interest

All authors participated in this study and have agreed on the content of this paper. None has any financial or other relationship that could lead to a conflict of interest. The research was approved by the Institutional Review Board.

Additional information

The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see: http://www.textcheck.com/certificate/06CPsS.

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Supplementary material 1 (DOCX 17 kb)

Supplementary Fig. 1

Overall survival (OS) and recurrence-free survival (RFS) curve after complete resection of 77 patients is shown. The 5-year OS rate after metastasectomy was 62.3% (A), and the 5-year RFS rate was 45.7% (B) (TIFF 63 kb)

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Ohtaki, Y., Shimizu, K., Aokage, K. et al. Histology is a Prognostic Indicator After Pulmonary Metastasectomy from Renal Cell Carcinoma. World J Surg 41, 771–779 (2017). https://doi.org/10.1007/s00268-016-3802-9

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  • DOI: https://doi.org/10.1007/s00268-016-3802-9

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