Clinical Characteristics Of Renal Cell Carcinoma Bone Metastases And Prognosis Factors Analysis Of Metastasectomy For Bone Metastases

Part one : Clinical analysis of 168 renal cell carcinoma patients with bone metastases Objective: The renal cell carcinoma patients with bone metastases are not rare and its incidence is growing with extension of the lifetime of metastatic renal cell carcinoma patients.This study aims to analyze the clinical characteristics of metastatic bone tumors for the further improvement of the understanding of bone metastases.Methods: Retrospective analysis was undergoing on the clinical data of 168 renal cell carcinoma patients with bone metastases in ChangZheng hospital affiliated to Navy military medical university from January 2012 to December 2018,all patients were confirmed by pathological examination,including patients’ baseline characteristics,tumor characteristics,as well as pathological features were collected.Descriptive analysis and difference analysis were used.There were 52 patients underwent nephrectomy and resection of bone metastases successively whose date were used for matched-pair analysis.Results: A total of 168 renal cell carcinoma patients with bone metastases were enrolled in this series.There were 141 males(83.9%)and 27 females(16.1%)in this series,the spine were the most frequent metastatic sites.85 patients recurrent bone metastases after surgery of kidney,the mean time of metastasis was 51.5 months after surgery of primary renal lesions.83 patients had bone metastases at the first attending time and 54 patients who had been diagnosed renal cell carcinoma with bone metastasis related symptom as the first manifestation.160 patients’ bone metastatic lesions can confirm renal cell carcinoma subtype,clear cell renal cell carcinoma is the most common subtype(93.7%).Fuhrman grade 3/4 proportion in both bone metastasis(49.3%)and matched patients(69.2%)are higher than non-selective renal cell carcinoma patients.Conclusions: Clear cell renal cell carcinoma is the highest morbidity subtype and is more prone to bone.Male,Fuhrman grade 3/4 and invasion of the renal capsule are high risk factors for bone metastasis,these patients should improve the long-term follow-up and reinforce bone survey.The expression of ki-67 is higher in bone metastases than in primary renal tumor.Part two: Prognosis factors analysis of metastasectomy for bone metastases from renal cell carcinomaMethods: Bone metastases(BMs)are associated with significant morbidity and shorter overall survival in renal cell carcinoma(RCC).Our purpose was to identify prognostic factors for overall survival in metastasectomy for bone metastases from renal cell carcinoma.Methods: Data from patients with bone metastases from renal cell carcinoma treated at Chang Zheng hospital affiliated to Navy military medical university between January 2012 and December 2018 were retrospectively collected.Age,sex,Memorial Sloan-Kettering Cancer Center(MSKCC)risk groups,International m RCC Database Consortium(IMDC)risk groups,the subtype of histology,nephrectomy,time to bone metastasis(TTBM),number and site of bone lesions,concomitant metastases(presence and sites),and time from nephrectomy to BMs were analyzed.Solitary bone metastasis was defined as a single BM at the initial diagnosis of RCC.Overall survival(OS)was calculated from the date of metastasectomy for bone metastases to death or last follow-up using Kaplan-Maier method and modelled with Cox regression analysis.A p-value of 0.05 or less was considered significant.Results: Among 168 patients,120 received operative treatments once,45 twice,3 with 3 times.There were 3 cases perioperative mortality,165 cases were followed up and 8 cases(4.8%)were lost.Follow-up time was 0-113 months.1,3,5 year survival rates are 77.4%,55.9%,31.8% respectively,and with a median survival of 43 months.Univariate analysis showed that gender,solitary bone metastasis,number and site of bone lesions,MSKCC risk group,IMDC risk group has significant effect on overall survival.At multivariate analysis,concomitant with other organ metastases remained predictor of poor prognosis,while MSKCC risk group,IMDC risk group were predictors of better overall survival.Conclusions: This study suggests that metastasectomy for resectable bone metastases is feasible.Solitary bone metastasis,MSKCC and IMDC score are important prognostic factors for patients.Therefore,in clinical practice,"stratified treatment" can be carried out according to risk models.Additionally,postoperative complications and mortality is a part of every surgeon’s thought processes-something with which all surgeons will be required to deal.