Outcome of patients with multiple glandular metastases from renal cell carcinoma treated with targeted agents

Abstract

Background: Pancreatic metastases (PM) from renal cell carcinoma (RCC) are rare and have been associated with long-term survival. The purpose of this study was to evaluate the outcome of RCC patients ( pts) with multiple glandular metastases (GM), defined as RCC metastasis to pancreas and at least one other gland including thyroid, parotid, adrenals, breast, ovaries or testes, treated with targeted therapies (TTs) Methods: GM pts treated between 1993 and 2014 were retrospectively identified from a database of RCC pts with PM of 11 European centers. Survival of GM pts was compared with that reported in either PM pts and in a population of 330 mRCC pts with extraglandular metastases treated with TTs at Istituto Nazionale Tumori between 2006 and 2012 (control group). Overall survival (OS) was defined as the time from diagnosis of metastatic disease to death. Survival functions were estimated using the Kaplan-Meier method for left-truncated data and statistically compared using the log-rank test Results: Among 276 PM pts, 64 pts with at least one additional GM were evaluated. Median age was 61 yrs, sex ratio M/F was 42/22, 59 pts (92%) received prior nephrectomy. Fifty-six pts (88%) had at least 2 additional GM, 7 pts (11%) had at least 3 GM and 1 pt had 4 GM. GM were the only metastasic site for 4 pts (6%) while extraglandular metastases were present in the remaining pts. First-line TTs included sunitinib, sorafenib, pazopanib, interferon + bevacizumab and temsirolimus, 28 pts (44%) reveived cytokines and 35 (56%) pts received subsequent lines of TTs. After a median follow-up of 58.8 months (IQR 26.4-106.8 mo) median OS was 56.4 months (95%CI 25.2-85.5 mo) for GM and 80.4 months (95%CI 64.8-99.6 mo) for PM pts. After a median follow-up of 51.6 months (IQR 27.6-63.6 mo) median OS in the control group was 22.8 months (95%CI 19.2-34.8 mo). OS in the control group was statistically inferior to either RCC pts with GM (p <0.001) and PM pts (p= 0.007) Conclusions: GM from RCC are associated with remarkable survival. Despite some limitations, these findings suggest that GM might be considered as a predictor of favorable prognosis. Sample collection for translational analysis would be critical to further characterize this rare metastastic pattern associated with a less aggressive disease.