title: The role of surgery in clinical management of patients with metastatic papillary renal cell carcinoma.
abstract: OBJECTIVE
  Patients with metastatic papillary renal cell carcinoma (RCC) show special clinical behavior compared to patients with other histologic subtypes of RCC. This study aimed to assess the relevance of surgical and systemic options used in treatment of these patients prior to the recent era of targeted therapies.
  
  
  METHODS
  Retrospectively, we assessed clinical data of 61 patients with metastatic papillary RCC who were treated at eight centers in Germany.
  
  
  RESULTS
  Median follow-up was 20 (range 1-114) months and median age at time of diagnosis was 62 (range 24-85) years. Men were affected predominantly (50/61; 82%). Twenty-one patients (34%) showed metastases at time of diagnosis. In the remaining 40 patients, median time to development of metastases was 30.4 (range 3-143; mean 16.5) months. Sites of metastases were lung (37; 61%), bone (24; 38%), liver (20; 33%), lymph nodes (24; 38%), and local recurrence (17; 28%). Others sites of disease were brain metastases (6 patients/10%), peritoneal carcinosis (5 patients/8%), and others. A surgical approach with potentially curative intention was performed primarily in 11 patients (18%). 31 patients received an immuno- (interferon-alpha +/- interleukin-2) or immunochemotherapy as first line treatment for metastatic disease. Overall, 42/61 patients (69%) received systemic therapy. Supportive care only was performed in 12 patients (20%) because of poor performance status. Median overall survival after diagnosis of metastatic disease was longer than 48 months in patients with tumor resection (n = 11) compared to 13.0 +/- 4.3 months 95% CI 4.5-21.5 (n = 42) months in patients without surgical approach.
  
  
  CONCLUSIONS
  Complete resection of metastases represents a valid option in management of patients with relapsing or metastatic papillary RCC.
authors.affiliation: Department of Urology, University Hospital Jena, Lessingstr 1, 07743 Jena, Germany. Thomas.steiner@med.uni-jena.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Steiner
authors.forename: Hartmut
authors.initials: H
authors.lastname: Kirchner
authors.forename: Michael
authors.initials: M
authors.lastname: Siebels
authors.forename: Christian
authors.initials: C
authors.lastname: Doehn
authors.forename: Hans
authors.initials: H
authors.lastname: Heynemann
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Varga
authors.forename: Detlef
authors.initials: D
authors.lastname: Rohde
authors.forename: Joerg
authors.initials: J
authors.lastname: Schubert
authors.forename: Dieter
authors.initials: D
authors.lastname: Jocham
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.forename: Paolo
authors.initials: P
authors.lastname: Fornara
authors.forename: Rainer
authors.initials: R
authors.lastname: Hofmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Loening
authors.forename: Jan
authors.initials: J
authors.lastname: Roigas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D002291:Carcinoma, Papillary / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery* / Q000628:therapy; D009367:Neoplasm Staging; D009392:Nephrectomy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome