title: Effect of number and location of distant metastases on renal cell carcinoma mortality in candidates for cytoreductive nephrectomy: implications for multimodal therapy.
abstract: OBJECTIVE
  To test whether the combination of number and location of distant metastases affects cancer-specific survival in patients with metastatic renal cell carcinoma.
  
  
  METHODS
  Overall, 242 metastatic renal cell carcinoma patients with synchronous metastases at diagnosis underwent cytoreductive nephrectomy at a single institution. Combinations of number and location of distant metastases were coded as: single metastasis and single organ affected, multiple metastases and single organ affected, single metastasis for each of the multiple organs affected, and multiple metastases for each of the multiple organs affected. Covariates included age, symptoms, performance status, American Society of Anesthesiologists score, hemoglobin, lactate dehydrogenase, tumor size, Fuhrman grade, T stage, lymph node status, necrosis, sarcomatoid features and metastasectomy at the time of nephrectomy.
  
  
  RESULTS
  The median survival was 34.7 versus 32.3 versus 29.6 versus 8.5 months for single metastasis and single organ affected, multiple metastases and single organ affected single metastasis for each of the multiple organs affected, and multiple metastases for each of the multiple organs affected patients, respectively. At multivariable analyses, the combination of number and location of distant metastases resulted in one of the most informative and independent predictors of cancer-specific survival in metastatic renal cell carcinoma patients. The lung was the location with the highest rate of single organ affected (50.3% vs 35.1% in other sites; P < 0.001). Considering only patients with a single metastasis, no statistically significantly different cancer-specific survival rates were recorded (P > 0.3) among different metastatic organs.
  
  
  CONCLUSIONS
  Among metastatic renal cell carcinoma patients undergoing cytoreductive nephrectomy, the combination of the number and location of distant metastases is a major independent predictor of cancer-specific survival. Patients with multiple organs affected by multifocal disease are more likely to have poorer survival.
authors.affiliation: Department of Urology, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy. umbertocapitanio@gmail.com
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Rayan
authors.initials: R
authors.lastname: Matloob
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Cristina
authors.initials: C
authors.lastname: Carenzi
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000556:secondary*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*