This study looked at where metastases occurred after surgery for high-risk non-metastatic renal cell carcinoma (RCC). The study also identified the factors that indicated outcomes for these patients.
A total of 1,057 patients with stage T3a or greater RCC were treated with surgery. 160 patients (59.3%) had one site of initial metastatic recurrence, while 110 (41.7%) patients had multiple sites of metastatic recurrence. The most common sites of metastatic recurrence were lung (53.3%), liver (20.0%) and bone (17.8%). Outside the chest and abdomen, recurrence occurred in 19.3% patients, most commonly in the pelvis (9.3%). Bone and brain were the most common organs for metastases outside the chest and abdomen. Patients with a tumour diameter greater than 10 cm and grade 4 were more likely to develop metastases in the bone and brain.
In conclusion, metastases developed outside the chest and abdomen in 1 of 5 high risk RCC patients, most commonly in the pelvis. Patients with large (>10 cm) tumours and grade 4 histology are at highest risk for bone and brain metastases.