Bone metastases from renal cell carcinoma: patient survival after surgical treatment

Background: Surgery is the primary treatment of skeletal metastases
from renal cell carcinoma, because radiation and chemotherapy
frequently are not effecting the survival. We therefore explored
factors potentially affecting the survival of patients after
surgical treatment. Methods: We retrospectively reviewed 101
patients operatively treated for skeletal metastases of renal cell
carcinoma between 1980 and 2005. Overall survival was calculated
using the Kaplan-Meier method. The effects of different variables
were evaluated using a log-rank test. Results: 27 patients had a
solitary bone metastasis, 20 patients multiple bone metastases and
54 patients had concomitant visceral metastases. The overall
survival was 58% at 1 year, 37% at 2 years and 12% at 5 years.
Patients with solitary bone metastases had a better survival (p
< 0.001) compared to patients with multiple metastases. Age
younger than 65 years (p = 0.036), absence of pathologic fractures
(p < 0.001) and tumor-free resection margins (p = 0.028)
predicted higher survival. Gender, location of metastases, time
between diagnosis of renal cell carcinoma and treatment of
metastatic disease, incidence of local recurrence, radiation and
chemotherapy did not influence survival. Conclusions: The data
suggest that patients with a solitary metastasis or a limited
number of resectable metastases are candidates for wide resections.
As radiation and chemotherapy are ineffective in most patients,
surgery is a better option to achieve local tumor control and
increase the survival.