The effects of surgical and medical treatments on the prognosis of synchronous metastatic renal cell cancer
Thesis event information
Date and time of the thesis defence
Place of the thesis defence
Oulu University Hospital, lecture room 1
Topic of the dissertation
The effects of surgical and medical treatments on the prognosis of synchronous metastatic renal cell cancer
Doctoral candidate
Licentiate of Medicine Lauri Laru
Faculty and unit
University of Oulu Graduate School, Faculty of Medicine, University of Oulu Graduate School, Research Unit of Translational Medicine, Medical Research Center Oulu
Subject of study
Medicine
Opponent
Professor Kari Tikkinen, University of Helsinki
Custos
Professor Juha Saarnio, University of Oulu
The effects of surgical and medical treatments on the prognosis of synchronous metastatic renal cell cancer
At diagnosis, 15–30% of patients with renal cell cancer (RCC) present with synchronous metastases. There is a scarcity of population-based publications on synchronous metastatic renal cell cancer (mRCC), but according to the available data, the prognosis is poor, with a median overall survival (OS) of 9–13 months.
In this dissertation, the study population consisted of patients with synchronous mRCC, diagnosed in 2005–2010. The comprehensive national data on these patients were collected from the Finnish Cancer Registry (FCR) and complemented with the patient reports from the treating hospitals.
In the first study of the thesis, we analysed 732 patients with synchronous mRCC and an Eastern Cooperative Oncology Group performance status of 0–2. We found a significant OS benefit from both cytoreductive nephrectomy (CN) and surgery with a curative intent compared with the no nephrectomy group. The OS benefit of surgical treatment was significant in both applied multivariable statistical models. However, CN was associated with relatively high complication rates, emphasising the importance of patient selection.
In the second study, we analysed the effects of the transition of medical treatment from cytokine-based therapy to targeted therapy (TT) in a study population of 977 patients. We found that a rapid change in standard medical treatment from cytokine-based therapy to TT, such as vascular endothelial growth factor receptor tyrosine kinase inhibitors, occurred between 2007 and 2008. The OS estimate of patients with synchronous mRCC improved after the introduction of TT, but the prognosis remained poor for the patients who were diagnosed in a late, symptomatic phase of the disease.
The third study evaluated the impact of surgical treatment of distant metastases on patients who also had CN. It included 483 patients. Complete and incomplete metastasectomy was performed for 57 and 96 patients, respectively. Complete metastasectomy was associated with significantly improved cancer-specific survival (CSS) and OS, whereas incomplete metastasectomy had no effect on the survival estimates.
According to our findings, the prognosis of synchronous mRCC in Finland is similar to other western countries and has improved along with the development of medical therapy. Both CN and complete metastasectomy have a role in the treatment of well-selected patients with synchronous mRCC.
In this dissertation, the study population consisted of patients with synchronous mRCC, diagnosed in 2005–2010. The comprehensive national data on these patients were collected from the Finnish Cancer Registry (FCR) and complemented with the patient reports from the treating hospitals.
In the first study of the thesis, we analysed 732 patients with synchronous mRCC and an Eastern Cooperative Oncology Group performance status of 0–2. We found a significant OS benefit from both cytoreductive nephrectomy (CN) and surgery with a curative intent compared with the no nephrectomy group. The OS benefit of surgical treatment was significant in both applied multivariable statistical models. However, CN was associated with relatively high complication rates, emphasising the importance of patient selection.
In the second study, we analysed the effects of the transition of medical treatment from cytokine-based therapy to targeted therapy (TT) in a study population of 977 patients. We found that a rapid change in standard medical treatment from cytokine-based therapy to TT, such as vascular endothelial growth factor receptor tyrosine kinase inhibitors, occurred between 2007 and 2008. The OS estimate of patients with synchronous mRCC improved after the introduction of TT, but the prognosis remained poor for the patients who were diagnosed in a late, symptomatic phase of the disease.
The third study evaluated the impact of surgical treatment of distant metastases on patients who also had CN. It included 483 patients. Complete and incomplete metastasectomy was performed for 57 and 96 patients, respectively. Complete metastasectomy was associated with significantly improved cancer-specific survival (CSS) and OS, whereas incomplete metastasectomy had no effect on the survival estimates.
According to our findings, the prognosis of synchronous mRCC in Finland is similar to other western countries and has improved along with the development of medical therapy. Both CN and complete metastasectomy have a role in the treatment of well-selected patients with synchronous mRCC.
Last updated: 29.8.2024