Comparison of prognostic factors that affect the survival of patients with metachronous and synchronous metastases of renal cell carcinoma

Abstract

Introduction. The differences in progression-free survival (PFS) and overall survival (OS) depending on the line of systemic therapy, the timing of the onset of metastases, and Heng prognostic groups in patients with metastatic renal cell carcinoma (mRCC) remain unclear. This leads to the search for new prognostic factors or their combinations, depending on the characteristics of the metastatic disease.Objective. To identify prognostic factors affecting survival rates in patients with synchronous and metachronous renal cell carcinoma metastases.Materials and methods. A retrospective analysis of 934 patients with mPCC treated in the period 2006 to 2020 was performed, of which 319 (34.2%) patients were assigned to the intermediate prognosis group, and 388 (41.5%) to the unfavorable prognosis group. Synchronous metastases (Smts) and metachronous metastases (Mmts) were detected in 380 (40.7%) and 554 (59.3%) patients, respectively. The clinical and morphological characteristics of the tumor were analyzed, as well as laboratory parameters. Statistical analysis was carried out using Statistica 10.0 software («StatSoft Inc.», Tulsa, OK, USA ) by constructing Kaplan-Meyer curves and survival tables, building a mathematical survival model.Results. The 3-year and 5-year OS of Smts-patients and Mmts-patients were 40.3% and 82.5%, 18.8% and 64.3% respectively. The median OS was 25 and 88 months, respectively (p < 0.001). The 3-year and 5-year PFS rates in Mmts-patients were 60.5% and 55.7%, respectively. In Smts-patients, PFS was only 9 months, compared with a median PFS of 60 months in Mmts-patients (p < 0.001). Anemia and elevated erythrocyte sedimentation rate were observed more frequently in Smts-patients. Mmts-patients were more likely to have normal platelet and alkaline phosphatase counts. Smts-patients more often had an unfavorable prognosis according to Heng and ECOG status, a higher T stage, a low tumor differentiation, and histologically, non-clear cell carcinoma variants, the presence of lymphogenous metastases, and an increased number of organs with metastatic lesions (p < 0.001). In univariate and multivariate analyses, OS in Smts- and Mmts-patients, anemia, and poor Heng prognosis were the only statistically significant prognostic factors. In a univariate analysis of OS of Smts-patients, increases in elevated erythrocyte sedimentation platelets, and alkaline phosphatase were significant adverse prognostic factors (p < 0.001).Conclusion. Research into new prognostic factors and their combinations, focusing on the specifics of the metastatic disease itself, will improve prediction outcomes and optimize systemic treatment outcomes.