title: Impact of synchronous metastasis distribution on cancer specific survival in renal cell carcinoma after radical nephrectomy with tumor thrombectomy.
abstract: OBJECTIVE
  Metastatic renal cell carcinoma can be clinically diverse in terms of the pattern of metastatic disease and response to treatment. We studied the impact of metastasis and location on cancer specific survival.
  
  
  METHODS
  The records of 2,017 patients with renal cell cancer and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1971 to 2012 at 22 centers in the United States and Europe were analyzed. Number and location of synchronous metastases were compared with respect to patient cancer specific survival. Multivariable Cox regression models were used to quantify the impact of covariates.
  
  
  RESULTS
  Lymph node metastasis (155) or distant metastasis (725) was present in 880 (44%) patients. Of the patients with distant disease 385 (53%) had an isolated metastasis. The 5-year cancer specific survival was 51.3% (95% CI 48.6-53.9) for the entire group. On univariable analysis patients with isolated lymph node metastasis had a significantly worse cancer specific survival than those with a solitary distant metastasis. The location of distant metastasis did not have any significant effect on cancer specific survival. On multivariable analysis the presence of lymph node metastasis, isolated distant metastasis and multiple distant metastases were independently associated with cancer specific survival. Moreover higher tumor thrombus level, papillary histology and the use of postoperative systemic therapy were independently associated with worse cancer specific survival.
  
  
  CONCLUSIONS
  In our multi-institutional series of patients with renal cell cancer who underwent radical nephrectomy and tumor thrombectomy, almost half of the patients had synchronous lymph node or distant organ metastasis. Survival was superior in patients with solitary distant metastasis compared to isolated lymph node disease.
authors: Department of Urology, University of California, Davis School of Medicine, Sacramento, California. Electronic address: derya.tilki@ucdmc.ucdavis.edu.
authors: Derya
authors: D
authors: Tilki
authors: Department of Urology, University of California, Davis School of Medicine, Sacramento, California; USC/Norris Comprehensive Cancer Center, Los Angeles, California.
authors: Brian
authors: B
authors: Hu
authors: Department of Urology, University of California, Davis School of Medicine, Sacramento, California.
authors: Hao G
authors: HG
authors: Nguyen
authors: Department of Urology, University of California, Davis School of Medicine, Sacramento, California.
authors: Marc A
authors: MA
authors: Dall'Era
authors: Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy.
authors: Roberto
authors: R
authors: Bertini
authors: Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
authors: Joaquín A
authors: JA
authors: Carballido
authors: Department of Urology, University of California, Davis School of Medicine, Sacramento, California.
authors: Thenappan
authors: T
authors: Chandrasekar
authors: Department of Urology, Medical University of Graz, Graz, Austria.
authors: Thomas
authors: T
authors: Chromecki
authors: Miami Transplant Institute, University of Miami, Miami, Florida.
authors: Gaetano
authors: G
authors: Ciancio
authors: USC/Norris Comprehensive Cancer Center, Los Angeles, California.
authors: Siamak
authors: S
authors: Daneshmand
authors: Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy.
authors: Paolo
authors: P
authors: Gontero
authors: Department of Urology, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain.
authors: Javier
authors: J
authors: Gonzalez
authors: Department of Urology, University of Frankfurt, Frankfurt, Germany.
authors: Axel
authors: A
authors: Haferkamp
authors: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors: Markus
authors: M
authors: Hohenfellner
authors: Department of Urology, New York University School of Medicine, New York, New York.
authors: William C
authors: WC
authors: Huang
authors: Department of Urology, Oregon Health & Science University, Portland, Oregon.
authors: Theresa M
authors: TM
authors: Koppie
authors: Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
authors: Estefania
authors: E
authors: Linares
authors: Department of Urology, Emory University, Atlanta, Georgia.
authors: C Adam
authors: CA
authors: Lorentz
authors: Institute of Empirical Economic Research, University of Leipzig, Leipzig, Germany.
authors: Philipp
authors: P
authors: Mandel
authors: Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
authors: Juan I
authors: JI
authors: Martinez-Salamanca
authors: Department of Urology, Emory University, Atlanta, Georgia.
authors: Viraj A
authors: VA
authors: Master
authors: Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy.
authors: Rayan
authors: R
authors: Matloob
authors: Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York.
authors: James M
authors: JM
authors: McKiernan
authors: Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York.
authors: Carrie M
authors: CM
authors: Mlynarczyk
authors: Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy.
authors: Francesco
authors: F
authors: Montorsi
authors: University of Padua, Padua, Italy.
authors: Giacomo
authors: G
authors: Novara
authors: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors: Sascha
authors: S
authors: Pahernik
authors: Department of Urology, Fundació Puigvert, Barcelona, Spain.
authors: Juan
authors: J
authors: Palou
authors: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Raj S
authors: RS
authors: Pruthi
authors: Department of Urology, New York University School of Medicine, New York, New York.
authors: Krishna
authors: K
authors: Ramaswamy
authors: Department of Urology, Fundació Puigvert, Barcelona, Spain.
authors: Oscar
authors: O
authors: Rodriguez Faba
authors: Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Paul
authors: P
authors: Russo
authors: Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors: Shahrokh F
authors: SF
authors: Shariat
authors: University of Würzburg, Würzburg, Germany.
authors: Martin
authors: M
authors: Spahn
authors: Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy.
authors: Carlo
authors: C
authors: Terrone
authors: Department of Urology, University of California, Davis School of Medicine, Sacramento, California.
authors: William
authors: W
authors: Thieu
authors: University of Würzburg, Würzburg, Germany.
authors: Daniel
authors: D
authors: Vergho
authors: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Eric M
authors: EM
authors: Wallen
authors: Department of Urology, Weill Cornell Medical Center, New York, New York.
authors: Evanguelos
authors: E
authors: Xylinas
authors: Department of Urology, Medical University of Graz, Graz, Austria.
authors: Richard
authors: R
authors: Zigeuner
authors: Department of Urology, Lahey Clinic, Burlington, Massachusetts.
authors: John A
authors: JA
authors: Libertino
authors: Department of Urology, University of California, Davis School of Medicine, Sacramento, California.
authors: Christopher P
authors: CP
authors: Evans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D009392:Nephrectomy / Q000379:methods; D015996:Survival Rate; D017131:Thrombectomy; D055815:Young Adult
keywords: carcinoma; inferior; neoplasm metastasis; prognosis; renal cell; survival; vena cava