Outcome after cytoreductive nephrectomy for metastatic renal cell carcinoma is predicted by fractional percentage of tumour volume removed

Abstract

To determine if the fractional percentage of tumour volume (FPTV) removed at cytoreductive nephrectomy predicts disease-specific survival (DSS), as metastatic renal cell carcinoma ((M+)RCC) is associated with poor overall survival with only a 10-20% patient survival at 2 years. The Columbia Urologic Oncology Database was reviewed; 1016 patients had renal surgery from 1988 to 2005, 78 patients with (M+)RCC underwent nephrectomy. The FPTV removed was determined using pathological and imaging reports. The patients were stratified as having a > or 90% FPTV. The median DSS times were 11.6 and 2.9 months for patients with >90% and 90% FPTV in a univariate model (P = 0.016) and 0.29 in multivariate analysis (P = 0.02). Patients with a <90% FPTV spent a greater percentage of time hospitalized before death, 21.2% vs 6.5% (P = 0.03). For patients with (M+)RCC, overall survival is limited, but can be extended by cytoreductive nephrectomy. The FPTV expected to be removed is a simple and available method to counsel patients regarding the benefits of surgical intervention.