title: Bone metastases in patients with metastatic renal cell carcinoma: are they always associated with poor prognosis?
abstract: OBJECTIVE
  Aim of this study was to investigate for the presence of existing prognostic factors in patients with bone metastases (BMs) from RCC since bone represents an unfavorable site of metastasis for renal cell carcinoma (mRCC).
  
  
  METHODS
  Data of patients with BMs from RCC were retrospectively collected. Age, sex, ECOG-Performance Status (PS), MSKCC group, tumor histology, presence of concomitant metastases to other sites, time from nephrectomy to bone metastases (TTBM, classified into three groups: <1 year, between 1 and 5 years and >5 years) and time from BMs to skeletal-related event (SRE) were included in the Cox analysis to investigate their prognostic relevance.
  
  
  RESULTS
  470 patients were enrolled in this analysis. In 19 patients (4%),bone was the only metastatic site; 277 patients had concomitant metastases in other sites. Median time to BMs was 16 months (range 0 - 44y) with Median OS of 17 months. Number of metastatic sites (including bone, p = 0.01), concomitant metastases, high Fuhrman grade (p < 0.001) and non-clear cell histology (p = 0.013) were significantly associated with poor prognosis. Patients with TTBM >5 years had longer OS (22 months) compared to patients with TTBM <1 year (13 months) or between 1 and 5 years (19 months) from nephrectomy (p < 0.001), no difference was found between these two last groups (p = 0.18). At multivariate analysis, ECOG-PS, MSKCC group and concomitant lung or lymph node metastases were independent predictors of OS in patients with BMs.
  
  
  CONCLUSIONS
  Our study suggest that age, ECOG-PS, histology, MSKCC score, TTBM and the presence of concomitant metastases should be considered in order to optimize the management of RCC patients with BMs.
authors: Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle, Marche, Ancona, Italy. mattymo@alice.it.
authors: Matteo
authors: M
authors: Santoni
authors: Department of Clinical and Specialist Sciences, Urology, Università Politecnica delle Marche, Ancona, Italy. alessandro.conti@hotmail.com.
authors: Alessandro
authors: A
authors: Conti
authors: Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. giuseppe.procopio@istitutotumori.mi.it.
authors: Giuseppe
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authors: Procopio
authors: Division of Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy. c.porta@smatteo.pv.it.
authors: Camillo
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authors: Porta
authors: Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, FC, Italy. t.ibrahim@irst.emr.it.
authors: Toni
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authors: Ibrahim
authors: Medical Oncology Department, Azienda Ospedaliera Treviglio-Caravaggio, Treviglio, Italy. sandro.barni@ospedale.treviglio.bg.it.
authors: Sandro
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authors: Barni
authors: Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy. f.guida@unicampus.it.
authors: Francesco Maria
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authors: Guida
authors: Unit of Medical Oncology 2, Istituto Toscano Tumori, Azienda-Ospedaliero-Universitaria Pisana, Pisa, Italy. an.fontana@ao-pisa.toscana.it.
authors: Andrea
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authors: Dipartimento di Specialità Medico-Chirurgiche, Medical Oncology, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Azienda Ospedaliera Spedali Civili, Brescia, Italy. alfredo.berruti@gmail.com.
authors: Alfredo
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authors: Berruti
authors: Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle, Marche, Ancona, Italy. r.berardi@univpm.it.
authors: Rossana
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authors: Department of Medical Oncology, "G.B. Rossi" Academic Hospital, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy. fmassari79@gmail.com.
authors: Francesco
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authors: Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy. b.vincenzi@unicampus.it.
authors: Bruno
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authors: Department of Medical Oncology, Institute for Cancer Research & Treatment (IRCC), Candiolo, Torino, Italy. cortega@ircc.mauriziano.it.
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authors: Department of Medical Oncology, Cardarelli Hospital, Naples, Italy. cartenigiacomo@gmail.com.
authors: Giacomo
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authors: Carteni
authors: Department of Neurological Sciences, Neuromed Institute, IRCSS, Pozzilli, IS, Italy. g_lanzetta58@hotmail.com.|Istituto Neurotraumatologico Italiano, Unità Funzionale di Oncologia, Grottaferrata, Italy. g_lanzetta58@hotmail.com.
authors: Gaetano
authors: G
authors: Lanzetta
authors: Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy. d.delisi@unicampus.it.
authors: Delia
authors: D
authors: De Lisi
authors: Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy. silvestrisnicola@libero.it.
authors: Nicola
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authors: Silvestris
authors: Department of Oncology, University of Turin, Medical Oncology 1, AOU Città della Salute e della Scienza, Turin, Italy. mariaantonietta.satolli@unito.it.
authors: Maria Antonietta
authors: MA
authors: Satolli
authors: Division of Medical Oncology, Hospital of Legnano, Milan, Italy. elena.collova@ao-legnano.it.
authors: Elena
authors: E
authors: Collovà
authors: Department of Surgery and Oncology, Section of Medical Oncology, University of Palermo, Palermo, Italy. antonio.russo@usa.net.
authors: Antonio
authors: A
authors: Russo
authors: Department of Surgery and Oncology, Section of Medical Oncology, University of Palermo, Palermo, Italy. giuseppe.badalamenti@unipa.it.
authors: Giuseppe
authors: G
authors: Badalamenti
authors: Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Presidio San Salvatore, Pesaro, Italy. s.luzifedeli@ospedalesansalvatore.it.
authors: Stefano
authors: S
authors: Luzi Fedeli
authors: Department of Medical Oncology, University of Cagliari, Cagliari, Italy. fmtanca@mail.com.
authors: Francesca Maria
authors: FM
authors: Tanca
authors: Department of Human Pathology, Medical Oncology Unit AOOR Papardo-Piemonte, University of Messina, Messina, Italy. adamovi@libero.it.
authors: Vincenzo
authors: V
authors: Adamo
authors: Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy. e.maiello@operapadrepio.it.
authors: Evaristo
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authors: Maiello
authors: Dipartimento Integrato di Oncologia ed Ematologia, Medical Oncology Division, Università degli Studi di Modena e Reggio Emilia, Modena, Italy. sabbatini@unimore.it.
authors: Roberto
authors: R
authors: Sabbatini
authors: Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy. alefelici01@gmail.com.
authors: Alessandra
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authors: Felici
authors: Medical Oncology Department & Breast Unit - Hospital of Brindisi and Medical Oncology Department - European Institute of Oncology, Milan, Italy. saverio.cinieri@ieo.it.
authors: Saverio
authors: S
authors: Cinieri
authors: Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy. r.montironi@univpm.it.
authors: Rodolfo
authors: R
authors: Montironi
authors: Department of Oncology, USL-8, Ospedale San Donato, Arezzo, Italy. sergio.bracarda@usl8.toscana.it.
authors: Sergio
authors: S
authors: Bracarda
authors: Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy. g.tonini@unicampus.it.
authors: Giuseppe
authors: G
authors: Tonini
authors: Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle, Marche, Ancona, Italy. s.cascinu@univpm.it.
authors: Stefano
authors: S
authors: Cascinu
authors: Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy. d.santini@unicampus.it.
authors: Daniele
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authors: Santini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality* / Q000556:secondary*; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
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