Metastatic renal cell carcinoma: Patterns and predictors of metastases—A contemporary population-based series

Thenappan Chandrasekar, Zachary W A Klaassen, Hanan Goldberg, Girish S. Kulkarni, Robert J. Hamilton, Neil E. Fleshner

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective To assess the patterns and predictors of metastatic disease in renal cell carcinoma (RCC) at the time of diagnosis in a contemporary series. Methods The Surveillance, Epidemiology, and End Results database was queried for all patients with kidney RCC from 2010 to 2013 (N = 50,815). Distribution and predictors of distant metastases at diagnosis were assessed. Multivariate logistic regression hazard analyses were performed to determine covariates associated with the likelihood of having metastases at diagnosis, whereas competing risks regression analysis was used to assess predictors of cancer-specific mortality (CSM) in patients with metastatic disease. Results Lung (7.73%) and bone (5.17%) metastases were the most common. The strongest predictors of metastatic disease were disease-specific factors, such as clinical T-stage (cT4 vs. cT1; odds ratio = 43.08; P<0.01) and higher Fuhrman grade (FG4 vs. FG1; odds ratio = 5.09; P<0.01). Papillary RCC and chromophobe RCC were associated with localized disease at the time of diagnosis. For CSM, the presence of brain and liver metastases were associated with worse CSM than lung or bone metastases. Although patient factors did not contribute to the presence of metastases at diagnosis, lower socioeconomic status and being widowed/divorced predicted worse CSM. Conclusion Understanding the distribution of distant metastases and associated CSM is important to counseling patients with newly diagnosed metastatic RCC. Although pathologic factors drive the presence of metastases at diagnosis, health care deficits in treatment remain.

Original languageEnglish (US)
Pages (from-to)661.e7-661.e14
JournalUrologic Oncology: Seminars and Original Investigations
Volume35
Issue number11
DOIs
StatePublished - Nov 1 2017
Externally publishedYes

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Renal Cell Carcinoma
Neoplasm Metastasis
Population
Mortality
Neoplasms
Odds Ratio
Regression Analysis
Bone and Bones
Widowhood
Lung
Divorce
Social Class
Counseling
Epidemiology
Logistic Models
Databases
Delivery of Health Care
Kidney
Liver
Brain

Keywords

  • Bone metastases
  • Distant metastases
  • Lung metastases
  • Outcomes
  • Renal cell carcinoma

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Metastatic renal cell carcinoma : Patterns and predictors of metastases—A contemporary population-based series. / Chandrasekar, Thenappan; Klaassen, Zachary W A; Goldberg, Hanan; Kulkarni, Girish S.; Hamilton, Robert J.; Fleshner, Neil E.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 35, No. 11, 01.11.2017, p. 661.e7-661.e14.

Research output: Contribution to journalArticle

Chandrasekar, Thenappan ; Klaassen, Zachary W A ; Goldberg, Hanan ; Kulkarni, Girish S. ; Hamilton, Robert J. ; Fleshner, Neil E. / Metastatic renal cell carcinoma : Patterns and predictors of metastases—A contemporary population-based series. In: Urologic Oncology: Seminars and Original Investigations. 2017 ; Vol. 35, No. 11. pp. 661.e7-661.e14.
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abstract = "Objective To assess the patterns and predictors of metastatic disease in renal cell carcinoma (RCC) at the time of diagnosis in a contemporary series. Methods The Surveillance, Epidemiology, and End Results database was queried for all patients with kidney RCC from 2010 to 2013 (N = 50,815). Distribution and predictors of distant metastases at diagnosis were assessed. Multivariate logistic regression hazard analyses were performed to determine covariates associated with the likelihood of having metastases at diagnosis, whereas competing risks regression analysis was used to assess predictors of cancer-specific mortality (CSM) in patients with metastatic disease. Results Lung (7.73{\%}) and bone (5.17{\%}) metastases were the most common. The strongest predictors of metastatic disease were disease-specific factors, such as clinical T-stage (cT4 vs. cT1; odds ratio = 43.08; P<0.01) and higher Fuhrman grade (FG4 vs. FG1; odds ratio = 5.09; P<0.01). Papillary RCC and chromophobe RCC were associated with localized disease at the time of diagnosis. For CSM, the presence of brain and liver metastases were associated with worse CSM than lung or bone metastases. Although patient factors did not contribute to the presence of metastases at diagnosis, lower socioeconomic status and being widowed/divorced predicted worse CSM. Conclusion Understanding the distribution of distant metastases and associated CSM is important to counseling patients with newly diagnosed metastatic RCC. Although pathologic factors drive the presence of metastases at diagnosis, health care deficits in treatment remain.",
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AU - Kulkarni, Girish S.

AU - Hamilton, Robert J.

AU - Fleshner, Neil E.

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N2 - Objective To assess the patterns and predictors of metastatic disease in renal cell carcinoma (RCC) at the time of diagnosis in a contemporary series. Methods The Surveillance, Epidemiology, and End Results database was queried for all patients with kidney RCC from 2010 to 2013 (N = 50,815). Distribution and predictors of distant metastases at diagnosis were assessed. Multivariate logistic regression hazard analyses were performed to determine covariates associated with the likelihood of having metastases at diagnosis, whereas competing risks regression analysis was used to assess predictors of cancer-specific mortality (CSM) in patients with metastatic disease. Results Lung (7.73%) and bone (5.17%) metastases were the most common. The strongest predictors of metastatic disease were disease-specific factors, such as clinical T-stage (cT4 vs. cT1; odds ratio = 43.08; P<0.01) and higher Fuhrman grade (FG4 vs. FG1; odds ratio = 5.09; P<0.01). Papillary RCC and chromophobe RCC were associated with localized disease at the time of diagnosis. For CSM, the presence of brain and liver metastases were associated with worse CSM than lung or bone metastases. Although patient factors did not contribute to the presence of metastases at diagnosis, lower socioeconomic status and being widowed/divorced predicted worse CSM. Conclusion Understanding the distribution of distant metastases and associated CSM is important to counseling patients with newly diagnosed metastatic RCC. Although pathologic factors drive the presence of metastases at diagnosis, health care deficits in treatment remain.

AB - Objective To assess the patterns and predictors of metastatic disease in renal cell carcinoma (RCC) at the time of diagnosis in a contemporary series. Methods The Surveillance, Epidemiology, and End Results database was queried for all patients with kidney RCC from 2010 to 2013 (N = 50,815). Distribution and predictors of distant metastases at diagnosis were assessed. Multivariate logistic regression hazard analyses were performed to determine covariates associated with the likelihood of having metastases at diagnosis, whereas competing risks regression analysis was used to assess predictors of cancer-specific mortality (CSM) in patients with metastatic disease. Results Lung (7.73%) and bone (5.17%) metastases were the most common. The strongest predictors of metastatic disease were disease-specific factors, such as clinical T-stage (cT4 vs. cT1; odds ratio = 43.08; P<0.01) and higher Fuhrman grade (FG4 vs. FG1; odds ratio = 5.09; P<0.01). Papillary RCC and chromophobe RCC were associated with localized disease at the time of diagnosis. For CSM, the presence of brain and liver metastases were associated with worse CSM than lung or bone metastases. Although patient factors did not contribute to the presence of metastases at diagnosis, lower socioeconomic status and being widowed/divorced predicted worse CSM. Conclusion Understanding the distribution of distant metastases and associated CSM is important to counseling patients with newly diagnosed metastatic RCC. Although pathologic factors drive the presence of metastases at diagnosis, health care deficits in treatment remain.

KW - Bone metastases

KW - Distant metastases

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