title: Treatment and survival of osseous renal cell carcinoma metastases.
abstract: BACKGROUND
  Renal cell carcinoma is the seventh leading cause of cancer deaths. Studies have shown patients with solitary osseous metastases have a better prognosis; however, methods of resection are not well defined. The purpose of this study was to review factors associated with survival and assess the impact of wide versus intralesional management on function and disease-specific outcomes in patients with renal cell carcinoma metastases.
  
  
  METHODS
  Sixty-nine patients with 86 osseous renal cell metastases were reviewed. Potential factors associated with survival were evaluated with Kaplan-Meier curves. ANOVA was performed to compare means between groups.
  
  
  RESULTS
  One year survival for the group was 77% and 32.5% at 5 years. The absence of metastatic disease at presentation, nephrectomy, and pre-operative status were associated with improved survival. There was a lower rate of local recurrence with wide resection (5%) versus intralesional procedures (27%).
  
  
  CONCLUSIONS
  Improved pre-operative status, nephrectomy, and metachronous lesions had better overall survival. Wide resection results in decreased local recurrence and revision surgeries. However, it did not reliably predict improved survival. Our recommendation is for individual evaluation of each patient with osseous renal cell carcinoma metastases. Wide excision may be used for resectable lesions to prevent local progression and subsequent surgeries.
authors.affiliation: University of Miami, Miller School of Medicine, Department of Orthopaedic Oncology, Miami, FL, USA. andrea.evenski@uphs.upenn.edu
authors.forename: Andrea
authors.initials: A
authors.lastname: Evenski
authors.forename: Shalini
authors.initials: S
authors.lastname: Ramasunder
authors.forename: William
authors.initials: W
authors.lastname: Fox
authors.forename: Varatharaj
authors.initials: V
authors.lastname: Mounasamy
authors.forename: H Thomas
authors.initials: HT
authors.lastname: Temple
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome