Adult urologyNumber of metastatic sites rather than location dictates overall survival of patients with node-negative metastatic renal cell carcinoma
Section snippets
Patient population
The records of 1087 patients treated at University of California, Los Angeles (UCLA) between 1989 and 2000 were reviewed, identifying 434 patients with mRCC. Patients with pathologic evidence of nodal disease were eliminated from comparison purposes because these patients do poorly regardless of treatment, leaving 297 patients available for evaluation. Three groups of patients who presented with metastases at the time of diagnosis were defined. Metastatic lesions to lung only were present in
Results
The mean age in each of the groups was 59.6 years (lung), 61.1 years (bone), and 57.5 years (multiple). The proportion of men was 78% in the lung group, 81% in the bone group, and 69% in the multiple organ group.
Table I summarizes the presentation characteristics of the three groups. Approximately 55% of the patients had T3 tumors. However, 16% of the primary tumors in the multiple organ group were Stage T4 compared with 7% and 4% in the lung only and bone only groups (P = 0.019), respectively.
Comment
The inclusion of prognostic factors in the analysis of survival data in patients with mRCC is of known importance. Motzer et al.15 recently reported that low Karnofsky score, increased lactate dehydrogenase and calcium levels, absence of nephrectomy, and development of anemia stratified patients into favorable-risk, intermediate-risk, and poor-risk groups with regard to prognosis.
In terms of site or number of metastatic deposits, recent investigators have reported conflicting results on whether
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