Massive endoprosthetic replacement for bone metastases resulting from renal cell carcinoma: factors influencing patient survival.
BACKGROUND
Surgery remains the main treatment of bone metastases due to renal cell carcinoma (RCC). We reviewed 135 patients treated with resection and endoprosthetic replacement (EPR) and examined clinico-pathological factors predicting survival.


METHODS
Surgical and oncological outcomes were examined using a prospectively maintained database between 1976 and 2012. Survival rates were calculated by Kaplan-Meier method. Multivariate analyses were performed to investigate factors predictive of increased survival.


RESULTS
At diagnosis, 81 patients had synchronous RCC and bone metastases and the remaining developed metachronous metastases after primary treatment for RCC. The majority were solitary tumours (75%) and 77% had ≥ one concurrent visceral metastases. The median age at surgery was 61 years old (IQR 53-69). The median follow-up was 20 months (IQR 10-43) and the overall survival was 72% at one-year. This declined to 45% and 28% at three and five-years, respectively. After adjustments for prognostic factors, there was an increased risk of death in patients with multiple skeletal metastases (HR = 2), ≥one visceral metastases (HR = 3) and local recurrence (HR = 3) (all p ≤ 0.01). Ten patients required revision (7%) and the risk of revision was 4% at one-year and remained low at 8% from two years postoperatively.


CONCLUSIONS
Patients with solitary bone lesions and no visceral metastases should be considered for bone resection and EPR. As survival beyond one-year can be expected in a majority of patients and the risk of further surgery after EPR is low, patients with multiple skeletal metastases and visceral metastases should also be considered.
Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK. Electronic address: Nick.hwang.8@gmail.com.
N
N
Hwang
Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK.
R
R
Nandra
Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK.
R J
RJ
Grimer
Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK.
S R
SR
Carter
Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK.
R M
RM
Tillman
Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK.
A
A
Abudu
Royal Orthopaedic Hospital, Birmingham (UK), Bristol Rd S, Northfield, Birmingham, B31 2AP, UK.
L M
LM
Jeys
D000368:Aged; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery*; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery*; D005260:Female; D005266:Femoral Neoplasms / Q000556:secondary / Q000601:surgery; D005269:Femur / Q000473:pathology / Q000601:surgery*; D005598:Fractures, Spontaneous / Q000209:etiology; D006801:Humans; D006811:Humerus; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D011884:Radius; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013977:Tibia; D016896:Treatment Outcome
Bone metastasis; Endoprosthetic replacement; Renal cell carcinoma; Survival rate