title: Prognostic factors for overall survival after lung metastasectomy in renal cell cancer patients: A systematic review and meta-analysis.
abstract: BACKGROUND
  Pulmonary metastasis of Renal cell carcinomas (RCC) is usually considered as a systemic disease. However, some studies revealed potential survival benefits of pulmonary metastasectomies for such patients. The aim of this study was to conduct a systematic review and meta-analysis to assess the prognostic factors for pulmonary metastasectomy of RCC patients.
  
  
  METHODS
  An electronic search in MEDLINE, EMBASE, CENTRAL and Chinese BioMedical Literature Database (CBM) were conducted to identify eligible studies. We combined the hazard ratios (HRs) of the identified prognostic factors for overall survival of RCC patients after pulmonary metastasectomy from the eligible studies.
  
  
  RESULTS
  Sixteen studies with a total of 1447 patients were included in this meta-analysis. The pooled 1, 3, 5, 10-year overall survival rates for RCC patient after pulmonary metastasectomy were 84%, 59%, 43% and 20%, respectively. The poor prognostic factors were lymph node involvement (LNI) of primary RCC (HR 3.44, 95% confidence interval (CI) 1.78-6.67, P = 0.001), incomplete resection of metastases (HR 3.74, 95% CI 2.49-5.61, P = 0.000), multiple metastases (HR 1.55, 95% CI 1.18-2.03, P = 0.002), larger metastases (HR 1.45, 95% CI 1.26-1.66, P = 0.000), LNI of metastases (HR 3.06, 95% CI 1.52-6.19, P = 0.002), synchronous metastasis (HR 2.49, 95% CI 1.46-4.24, P = 0.001) and short disease free interval (DFI).
  
  
  CONCLUSIONS
  Surgery may be a promising treatment for pulmonary metastases of RCC patients. A short DFI, LNI of primary RCC, incomplete resection of metastases, multiple metastases, larger metastases, LNI of metastases and synchronous metastasis are predictors of poor survival after pulmonary metastasectomy for RCC patients.
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Guoxuexiang, No. 37, Chengdu, 610041, Sichuan, China; Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
authors.forename: Yongsheng
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Guoxuexiang, No. 37, Chengdu, 610041, Sichuan, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Guoxuexiang, No. 37, Chengdu, 610041, Sichuan, China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Guoxuexiang, No. 37, Chengdu, 610041, Sichuan, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Fan
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Guoxuexiang, No. 37, Chengdu, 610041, Sichuan, China. Electronic address: lunxu_liu@aliyun.com.
authors.forename: Lunxu
authors.initials: L
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery*; D059146:Metastasectomy / Q000379:methods*; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Meta-analysis; Prognostic factors; Pulmonary metastases; Renal cell cancer; Systematic review