title: Prospective assessment of systemic therapy followed by surgical removal of metastases in selected patients with renal cell carcinoma.
abstract: OBJECTIVE
  To prospectively establish objective selection criteria for metastasectomy in patients with metastatic renal cell carcinoma (mRCC).
  
  
  METHODS
  Between 1991 and 1999, 38 patients with mRCC with responsive or stable disease after initial systemic therapy, and with potentially resectable disease, were enrolled. Patients had a metastasectomy with curative intent and received consolidative adjuvant systemic therapy.
  
  
  RESULTS
  Of the patients enrolled, 79% had stable disease after initial systemic therapy and 21% had a partial or complete response. Most (84%) had metastasectomy of one organ site. There was surgically no evidence of disease (sNED) in 76%. Operative morbidity and mortality were acceptable and 90% of the patients received adjuvant systemic therapy. The median (95% confidence interval) survival was 4.7 (3.0-7.8) years, and the median time to progression was 1.8 (0.8-3.1) years. Eight of 38 patients (21%) remained free of disease by the end of the study. Significant predictors of outcome were lack of sNED after metastasectomy, and the presence of pulmonary metastases. The median overall survival for those who had sNED was 5.6 years, vs 1.4 years for those who did not (P < 0.001).
  
  
  CONCLUSIONS
  Metastasectomy in patients with mRCC not progressing after systemic therapy is feasible, with acceptable morbidity. Predictive factors for long-term outcome include pulmonary metastases and sNED. Future work evaluating treatments that can convert patients into surgical candidates will increase the cure rate of patients with mRCC.
authors.affiliation: Medical Oncology Department, University Hospital of Larissa, Mzourlo, Larrissa, Greece.
authors.forename: Danai D
authors.initials: DD
authors.lastname: Daliani
authors.forename: Nizar M
authors.initials: NM
authors.lastname: Tannir
authors.forename: Christos N
authors.initials: CN
authors.lastname: Papandreou
authors.forename: Xuemei
authors.initials: X
authors.lastname: Wang
authors.forename: Stephen
authors.initials: S
authors.lastname: Swisher
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: David A
authors.initials: DA
authors.lastname: Swanson
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Logothetis
authors.forename: Eric
authors.initials: E
authors.lastname: Jonasch