ENDOUROLOGY & LAPAROSCOPY

Risk score and metastasectomy independently impact prognosis of patients with recurrent renal cell carcinoma
Eggener SE, Yossepowitch O, Kundu S, Motzer RJ, Russo P.
Department of Urology and Division of Solid Tumor Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
J Urol. 2008; 180: 873-8; discussion 878

• Purpose: We evaluated the prognostic roles of metastasectomy and an established risk stratification system in patients with disease recurrence following nephrectomy for nonmetastatic renal cell carcinoma.
• Materials and Methods: A retrospective analysis was performed in 129 patients with localized renal cell carcinoma treated with partial or radical nephrectomy and subsequently diagnosed with disease recurrence. At recurrence a previously validated risk score based on Karnofsky performance status, interval from nephrectomy, and serum hemoglobin, calcium and lactate dehydrogenase was used to categorize patients as being at favorable, intermediate or poor risk. Survival from time of recurrence was assessed based on risk categorization and metastasectomy.
• Results: Median time from nephrectomy to recurrence was 16 months. The risk score was strongly associated with median survival and the 2-year survival rate, including 73 months and 81% for favorable risk, 28 months and 54% for intermediate risk, and 6 months and 11% for poor risk, respectively (log rank < 0.001). Metastasectomy performed in 44 patients (34%) was found to be of clinical benefit across the various risk categories (interaction analysis p = 0.8). On multivariate analysis a better risk category and metastasectomy were each independently associated with more favorable survival (each p < 0.001). When combined, they provided 6 risk categories with an estimated 2-year survival of 0% to 93%.
• Conclusions: The clinical course in patients with recurrent renal cell carcinoma following nephrectomy can be variable. It is independently impacted by an objectively determined risk score and whether the patient undergoes metastasectomy.
  
  
• Editorial Comment
  This retrospective study demonstrated prognostic roles of metastasectomy and an established risk stratification system in patients with disease recurrence following nephrectomy for nonmetastatic renal cell carcinoma.
  Although the metastectomy may improve survival in the favorable group, the limitations of this retrospective study still do not answer all the questions for the less favorable group of patients.
  With the advent of new targeted therapy drugs and better stratification of these patients it is possible that we will improve the lives of these patients.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA
E-mail: fernando.kim@uchsc.edu