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Pancreatic metastases after surgery for renal cell carcinoma: survival and pathways of progression

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Abstract

Purpose

Metastatic ccRCC has peculiar tropism in the pancreas. We describe the characteristics and pathways of progression of patients with PM in a large multi-institutional consortium and compare them to patients with metastases from ccRCC at other sites.

Methods

Detailed clinical and histopathological data were collected. To account for differences in baseline characteristics between the two groups, IPTW was used to compare the two groups in terms of PFS and OS.

Results

Of the 182 patients, 33 (18%) had pancreatic, 94 (52%) pulmonary, 30 (16%) bone, 13 (7%) hepatic, and 12 (7%) brain metastases. Patients with PM had less aggressive ccRCC at baseline compared to those with progression at other sites in terms of tumour stage and grade. Median time from ccRCC surgery to PM was 8 (95%CI 5–10) vs. 1 year (95%CI 1–2) for progression to other sites (p < 0.001). Median IPTW-weighted time to second progression was 4.3 years (95%CI 2.4-not reached) for patients with PM vs 1.1 year (95%CI 0.8–2.3) for those with progression in other sites (p < 0.001). The most frequent second progression sites were pancreas (24%) and liver (15%) in patients with PM, while progression to the pancreas was rare (4%) in those with a different first progression site. Surgery alone (55%) or in combination with medical therapy (30%) was more frequent in the PM group than in other sites (p < 0.001). Median IPTW-OS time was longer for patients with PM [8.8 years (95%CI 6.5-not reached)] compared to those with first progression in other sites [2.8 years (95%CI 1.9–4.3), p < 0.001].

Conclusion

Pancreatic tropism is typical of ccRCC tumours with more indolent behaviour than those progressing to other sites. A long follow-up period is necessary to distinguish PM from ccRCC.

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Abbreviations

ccRCC:

Clear Cell Renal Cell Carcinoma

mRCC :

Metastatic renal cell carcinoma

PM :

Pancreatic metastasis

CCI :

Charlson Comorbidity Index

ECOG :

Eastern Cooperative Oncology Group performance status

PFS :

Progression free survival

OS :

Overall survival

CSS :

Cancer-specific survival

IPTW :

Inverse probability of treatment weighting

IQR :

Interquartile range

IMDC :

 International Metastatic Database Consortium

EAU :

 European Association of Urology

BMI :

Body mass index

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Acknowledgements

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Author notes

  1. Daniele Cignoli and Giuseppe Fallara are contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Daniele Cignoli, Giuseppe Fallara, Alessandro Larcher, Giuseppe Rosiello, Isaline Rowe, Giuseppe Basile, Gianmarco Colandrea, Alberto Martini, Francesco Montorsi, Andrea Salonia & Umberto Capitanio

  2. IRCCS San Raffaele Scientific Institute, Pancreas Translational & Clinical Research Center, Pancreatic Surgery Unit, Vita-Salute San Raffaele University, Milan, Italy

    Francesca Aleotti, Stefano Partelli, Domenico Tamburrino & Massimo Falconi

  3. Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Francesco De Cobelli & Giorgio Brembilla

  4. Department of Pathology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Roberta Lucianò, Maurizio Colecchia & Marco Schiavo Lena

  5. Department of Pathology, IRCCS, Ospedale Sacro Cuore Don Calabria, University of Verona, Verona, Italy

    Giuseppe Zamboni

  6. Pathology, Dip. Di Scienze Biomediche E Sanità Pubblica, Polytechnic University of Marche, Ancona, Italy

    Corrado Rubini

Authors
  1. Daniele Cignoli
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  2. Giuseppe Fallara
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Contributions

DC, GF, FA, AL, MC, MF, AS, FM, UC: study conception and design; DC, GF, FA: acquisition of data; DC, GF, AL, UC: analysis and interpretation of data; DC, GF, AL, UC: drafting of the manuscript; AS, MF, MC, FM, UC: critical revision of the manuscript for important intellectual content; DC, GF, AL, UC: statistical analysis; none: obtaining funding; AS, MF, FM, UC: supervision; all the authors contributed to the revision and improvement of the manuscript.

Corresponding author

Correspondence to Umberto Capitanio.

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Cignoli, D., Fallara, G., Aleotti, F. et al. Pancreatic metastases after surgery for renal cell carcinoma: survival and pathways of progression. World J Urol 40, 2481–2488 (2022). https://doi.org/10.1007/s00345-022-04106-z

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  • DOI: https://doi.org/10.1007/s00345-022-04106-z

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