Introduction

Over the past several years, a major international study collaboration has occurred among centers of excellence caring for kidney cancer termed the Latin American Renal Cancer Group (LARCG). The aim of the present study is to assess the impact of clinical and pathologic variables on cancer specific survival (CSS) and overall survival (OS).

Methods

Analysis of data from 28 centers from 8 countries, revealed 4,060 patients with renal cell carcinoma (RCC) who underwent nephrectomy from 1990 to 2015, 530 of which (14.5%) had metastasis at clinical presentation. These are the focus of the present study. Median follow-up was six months (0-162). Of 455 patients with survival data, 203 died (44.6%), 184 (90.6%) of RCC.

Results

The median age of patients with metastatic RCC (mRCC) was 61 (23-71) years, 68% of patients were male and 32% female (2:1 ratio). The organs most frequently affected with metastasis were lungs (45.5%), bone (21.5%), lymph nodes (10.6%), liver (8.7%), adrenal (4%) and brain (2.2%). On univariate analysis, there were associations between 5-year OS and CSS and presence of ECOG-PS ≥1 (p=0.005 and p=0.007, respectively), ASA 3 classification (p<0.0001, for both), pT 3-4 (p=0.019 and p=0.009 respectively), pN1 (p=0.001 and p<0.0001), Fuhrman grades ≥3 (p=0.010 and p=0.008 respectively), Necrosis (p=0.024 and p=0.016), perirenal fat invasion (p<0.0001, for both), Hemoglobin <11 (p=0.001 and p=0.002), multiple metastases (p=0.002 and p=0.001), two or more involved organs (p=0.002 and p=0.005, respectively), bone vs pulmonary metastasis (p=0.017 and p=0.024), vertebral metastasis (p=0.035, for both), and more than five lungs metastases (p=0.003 for both). On multivariate analysis, the independent prognostic factor of 5-year OS was the ASA (p=0.020). Both OS and CSS were influenced by perirenal fat invasion (p=0.001 for both), and two or more metastatic organ sites (p<0.0001 and p=0.003 respectively).

Conclusions

This study of the impact of clinical and pathologic variables on survival in mRCC in Latin America was possible thanks to the collaborative work done by the LARCG. The presence of two or more sites of metastasis and the presence of perirenal fat invasion within the primary tumor predict shorter OS and CSS. ASA Classification was an independent predictor of OS.

Funding

None