Abstract
Background
The management of metastatic renal cell carcinoma (mRCC) has been transformed by the use of targeted therapies, ablative therapies and improved surgical techniques. The objective of this study was to identify therapeutic strategies that resulted in complete remission (CR) and to assess survival of patients in CR.
Methods
In a prospective database, we included all patients treated for mRCC at a university hospital between 2007 and 2015. CR was defined as the absence of metastasis after a full-body computed tomographic scan.
Results
We treated 77 patients with mRCC and experienced a CR in 22 (29 %) patients. Patients in CR had, respectively, synchronous and metachronous metastases in 7 (32 %) and 15 (68 %) cases and unique and multiple metastases in 4 (18 %) and 18 (82 %) cases. All patients were treated with cytoreductive nephrectomy and 21 (96 %) had metastasectomy or percutaneous ablation of their metastases. One patient had a CR after systemic treatment with sunitinib. After a median (range) follow-up since metastatic diagnosis of 35 (1–89) months, 12 patients (55 %) had disease recurrence. The median (range) duration of CR before recurrence was 14 (1–39) months. After recurrence, a new CR was obtained in 7 patients (58 %). At the end of follow-up, 16 patients (73 %) were still in CR, 5 (23 %) were undergoing medical treatment, and 1 patient died during the postoperative course.
Conclusions
In the era of targeted-therapies, CRs were obtained with multimodal treatment of metastatic kidney cancer. All patients in CR had a nephrectomy and almost all of them had multiple metastasectomies.
Similar content being viewed by others
References
Jemal A, Siegel R, Ward E, et al. Cancer statistics. 2008. CA Cancer J Clin. 2008;58(2):71–96.
Ljungberg B, Campbell SC, Choi HY, et al. The epidemiology of renal cell carcinoma. Eur Urol. 2011;60(4):615–21.
Flanigan RC, Salmon SE, Blumenstein BA, et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med. 2001;345(23):1655–9.
Mickisch GH, Garin A, van Poppel H, et al. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet. 2001;358(9286):966–70.
Patard JJ, Baumert H, Bensalah K, et al. [CCAFU recommendations 2013: renal cancer]. Prog Urol. 2013;23(Suppl 2):S177–204.
Russo P. Multi-modal treatment for metastatic renal cancer: the role of surgery. World J Urol. 2010;28(3):295–301.
Alt AL, Boorjian SA, Lohse CM, et al. Survival after complete surgical resection of multiple metastases from renal cell carcinoma. Cancer. 2011;117(13):2873–82.
Albigès L, Choueiri T, Escudier B, et al. A systematic review of sequencing and combinations of systemic therapy in metastatic renal cancer. Eur Urol. 2015;67(1):100–10.
Heng DY, Xie W, Regan MM, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol. 2009;27(34):5794–9.
Moch H, Artibani W, Delahunt B, et al. Reassessing the current UICC/AJCC TNM staging for renal cell carcinoma. Eur Urol. 2009;56(4):636–43.
Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982;6(7):655–63.
Lopez-Beltran A, Scarpelli M, Montironi R, et al. 2004 WHO classification of the renal tumors of the adults. Eur Urol. 2006;49(5):798–805.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
Buchler T, Bortlicek Z, Poprach A, et al. Outcomes for patients with metastatic renal cell carcinoma achieving a complete response on targeted therapy: a registry-based analysis. Eur Urol. 2016 Sep;70(3):469–75.
Albigès L, Oudard S, Negrier S, et al. Complete remission with tyrosine kinase inhibitors in renal cell carcinoma. J Clin Oncol. 2012;30(5):482–7.
Cloutier V, Capitanio U, Zini L, et al. Thirty-day mortality after nephrectomy: clinical implications for informed consent. Eur Urol. 2009;56(6):998–1003.
Silberstein JL, Adamy A, Maschino AC, et al. Systematic classification and prediction of complications after nephrectomy in patients with metastatic renal cell carcinoma (RCC). BJU Int. 2012;110(9):1276–82.
Gershman B, Moreira DM, Boorjian SA, et al. Comprehensive characterization of the perioperative morbidity of cytoreductive nephrectomy. Eur Urol. 2016;69(1):84–91.
Karam JA, Rini BI, Varella L, et al. Metastasectomy after targeted therapy in patients with advanced renal cell carcinoma. J Urol. 2011;185(2):439–44.
de Baere T, Auperin A, Deschamps F, et al. Radiofrequency ablation is a valid treatment option for lung metastases: experience in 566 patients with 1037 metastases. Ann Oncol. 2015;26(5):987–91.
Dabestani S, Marconi L, Hofmann F, et al. Local treatments for metastases of renal cell carcinoma: a systematic review. Lancet Oncol. 2014;15(12):e549–61.
Conflict of interest
The authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Brécheteau, F., Lebdai, S., Carrouget, J. et al. How Did We Obtain Complete Remission in Patients Who Had Metastatic Renal Cancer in the Era of Targeted Therapies?. Ann Surg Oncol 24, 369–374 (2017). https://doi.org/10.1245/s10434-016-5587-3
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-016-5587-3