Nephrology & Urology Xagena

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Pancreatic metastases from renal cell carcinoma: clinical impact

Pancreatic metastases from renal cell carcinoma are uncommon and their prognostic significance is not well defined. Br>
An analysis has evaluated the outcome of patients with pancreatic metastases treated with either targeted therapies or local treatment to the pancreas.
Patients with pancreatic metastases from renal cell carcinoma treated between 1993 and 2014 were identified from 11 European centers. Clinical records were retrospectively reviewed.

In total, 276 patients with pancreatic metastases were evaluated, including 77 ( 28% ) patients treated by either surgery or radiotherapy to the pancreas, and 256 ( 93% ) who received systemic therapy.

Median time from nephrectomy to diagnosis of pancreatic metastases was 91 months ( IQR 54-142 ).

Disease control rate after first-line targeted therapies was 84%, with a median progression-free survival of 12 months ( 95% CI 10-14 ).

Median overall survival was 73 months ( 95% CI 61-86 ) with a 5-year overall survival of 58%. Median overall survival of patients treated with local treatment was 106 months ( 95% CI 78-204 ) with a 5-year overall survival of 75%.

On multivariable analysis, nephrectomy ( hazard ratio, HR=5.31; 95%CI 2.36-11.92; p less than 0.0001 ), Memorial Sloan Kettering / International Metastatic RCC Database Consortium prognostic score ( HR=1.45, 95% CI 0.94-2.23 for intermediate vs good risk; HR=2.76 95%, CI 1.43-5.35 for poor vs good risk p = 0.0099 ) and pancreatic local treatment ( HR=0.48; 95% CI 0.30-0.78 p = 0.0029 ) were associated with overall survival.

Difference in median overall survival between patients with pancreatic metastases and that reported in a matched-control group of mRCC patients with extrapancreatic metastases was statistically significant ( p less than 0.0001 ).
Pancreatic metastases from renal cell carcinoma usually occur years after nephrectomy, are associated with an indolent behavior and a prolonged survival.
Targeted therapies and locoregional approaches are active and achieve high disease control rate. ( Xagena )

Grassi P et al, PLoS One 2016;11(4):e0151662