The influence of the primary tumor on the long-term results of pulmonary metastasectomy for metastatic renal cell carcinoma.

OBJECTIVE: To investigate one of the primary tumor (PT) on pulmonary metastasectomy (PM) for metastatic renal cell carcinoma (RCC) and to define prognostic factors.

METHODS: Retrospective review of patients with pulmonary metastases from RCC from January 1999 through December 2008 was performed. All patients underwent PM with curative intend. TNM-classification, tumor stage and PT grade, disease-free-interval (DFI) from nephrectomy to the diagnosis of metastasis, systemic chemotherapy before surgical intervention, surgical procedures, morbidity, mortality, and survival were investigated.

RESULTS: One-hundred seven consecutive patients (age 61.5 ± 9.6 years) underwent PM. Morbidity and mortality rates were 15.0 and 0.9%, respectively. Thirty-six patients (33.6%) had systematic therapy before PM. Complete resections could be achieved in 104 patients (97.2%). Mean survival was 63.4 ± 5.1 months. The overall 5- and 10-year survival rates were 47 and 9%, respectively. Advanced N-Status (p < 0.001), grade (p < 0.001) and stage group (stage I/II vs. III/IV, p = 0.022) of the PT were associated with inferior survival in the univariate analysis. T-Status (p = 0.89) and M-Status (p = 0.96) of the PT had no significant impact on survival. In a multivariable Cox proportional hazards model, N-Status and tumor grade were the only significant prognostic factors.

CONCLUSIONS: PM can be performed safely. Long-term survival is achievable in selected patients. Nodal disease and high tumor grade of the PT at the time of the initial nephrectomy were associated with worse survival after PM. These results might help to identify a high-risk group of patients who might benefit from enrollment in adjuvant therapy protocols after primary treatment of RCC.