title: Pattern of metastases in renal cell carcinoma: a single institution study.
abstract: BACKGROUND
  Increasing numbers of patients with renal cell carcinoma (RCC) are incidentally detected and can be potentially cured by surgery alone. In treating metastatic RCC, worthwhile survival rates are achieved in cases of low burden recurrences. This necessitates a rational follow up protocol, which picks up early recurrences and avoids costly surveillance for those with a favorable prognosis.
  
  
  OBJECTIVE
  We studied the patterns of metastases occurring in patients operated for localized or locally advanced renal cell carcinoma in the Indian setting and try to evolve a suitable follow up protocol.
  
  
  METHODS
  Institution based, retrospective data.
  
  
  METHODS
  Records of patients from January 1988 to December 2003, operated for initially localized RCC were reviewed. Follow up was performed using an established protocol. Occurrence of metastases and their patterns were studied.
  
  
  METHODS
  Comparison of the different survival times was performed using the one-way analysis method. Multiple comparisons (post hoc test) were performed using the Bonferroni method.
  
  
  RESULTS
  Follow up was available on 209 patients. Mean survival was 43.75 months (SD +/- 28.72). Thirty-nine patients developed 59 metastases. Lungs were the commonest site of metastases (37%), followed by bone (22%), liver (19%) and brain (8%). Relapse and survival showed significant correlation with pathological stage (p
  
  
  CONCLUSIONS
  Occurrence of metastases correlate with the pathological stage of the disease at primary presentation. Tailored, stage-based follow up protocols allow adequate surveillance for disease activity and progression without escalating the overall costs.
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: B
authors.initials: B
authors.lastname: Sivaramakrishna
authors.forename: Narmada P
authors.initials: NP
authors.lastname: Gupta
authors.forename: Pankaj
authors.initials: P
authors.lastname: Wadhwa
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Hemal
authors.forename: Prem N
authors.initials: PN
authors.lastname: Dogra
authors.forename: Amlesh
authors.initials: A
authors.lastname: Seth
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kumar
mesh_terms: D001707:Biopsy, Needle; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007194:India / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D008297:Male; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009392:Nephrectomy; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome