Surgical treatment of advanced renal cell carcinoma

BACKGROUND: We studied the indication and the limitation of surgical treatment for advanced renal cell carcinoma (RCC) based upon the survival rate for 48 patients (recurrent in 37, stage 4B in 11) who received the surgical therapy for the metastatic lesions. METHODS: We examined many factors including performance status (P.S.), laboratory findings, initial stages, surgical curability, operated organs, combined treatments with operation and grade of primary lesion in subjected patients. RESULTS: Regarding the performance status (P.S.) of the patients, those with P.S. 0 showed a favourable survival compared with those with P.S. 1 and 2, and significant differences were observed. Furthermore, the patients with P.S. 1 showed a favourable survival compared with those with P.S. 2, and a significant difference was observed between these two groups. The patients who manifested 2 or more abnormalities of the acute phase reactants showed unfavourable survival compared with those who manifested 1 or less abnormalities of the acute phase reactants, and a significant difference was observed between these two groups. As to the stage of the patients with stages 1 and 2 at their initial presentation, the patients who received the surgical treatment showed a favourable survival compared with those who did not, and significant differences were observed. As to the patients with stage 4B, although their clinical background was quite different, the patients who received the surgical treatment also showed a favourable survival compared with those who did not, and a significant difference was observed. In an analysis of the curability obtained by surgical procedures, the patients who were thought to have the curable surgery showed a favourable survival compared with those who were thought to have non-curable surgery, but no significant difference was observed between these two groups. In an analysis of the organs excised as a treatment for metastasis, the patients who underwent the operation for the affected adrenal gland and lung showed a relatively favourable survival. On the other hand, the patients who underwent the operation for the contralateral adrenal gland and pancreas showed an unfavourable survival. Regarding the combination treatment with operation, the patients who received the interferon and interleukin-2 treatment showed a favourable survival. No significant difference was observed among any combination treatments if operation was omitted from the combination. Regarding the grade of primary lesion, no consistent trend was observed. CONCLUSION: These results suggest that the surgical treatment should be indicated based upon the P.S. of the patients, the findings of acute phase reactants and the stage at the initial presentation of patients. Furthermore, the metastatic organs and the application of cytokine must be considered in the treatment of advanced RCC.