Surgical effect and survival-related factors study for patients with spinal metastasis of renal clear cell carcinoma

English Keywords:Renal clear cell carcinoma  Spinal metastasis  Surgical treatment  Surgical effect

English Abstract:

  【Abstract】 Objectives: This study aims to explore the effect of surgical treatment and survival-related factors of patients with spinal metastasis of renal clear cell carcinoma. Methods: The data of 45 patients who underwent surgery for spinal metastasis of renal clear cell carcinoma from January 2008 to December 2019 were retrospectively analyzed. Of the patients, there were 34 males and 11 females with a mean age of 60.1±7.6 years and an average course of disease of 4.3±4.4 months (range 1 to 24 months). And 25 patients were of Frankel grade E, 17 were of grade D, 1 of grade C and 2 of grade B before operation. Among the patients, 10 were with visceral metastasis and 16 were with extraspinal bone metastasis. The patients were divided into tumor resection group(with debulking surgery and total spondylectomy) and palliative decompression group according to the surgical options. Intraoperative blood loss and surgical complications were collected. All the patients were followed up, and they were divided into terminal group(died) and follow-up(alive) group according to the survival status. Pain relief, quality of life, nerve function evaluation, and radiological examination result within six months before follow-up of the follow-up group of patients were recorded. Median overall survival and survival curve were obtained via Kaplan-Meier method. Univariate analysis was performed for all the factors possibly related to survial, after which, multivariate COX analysis was performed for factors with statistical difference. Results: The minimum follow-up time was 12 months. At final follow-up, there were 30 patients in follow-up group and the average follow-up time was 36.7±31.6 months. Median overall survival was 81.0 months. One-year, two-year and three-year survival rates after surgery were 84.4%, 78.6% and 70.2%, respectively. In follow-up group, the average numeric rating scale(NRS) score was 6.0±2.4(1 to 10) before surgery and 2.9±2.7(0 to 8) at follow-up. 19 patients obtained obvious pain relief after surgery(NRS score reduced more than 3). The average KPS score was 71.3±14.3(30 to 90) before surgery and 70.0±12.2(40 to 90) at follow-up time. 29 patients were Frankel D or E at final follow-up, and among which 6 improved and 14 remained the same compared with pre-operation. Cervical spinal metastasis(P=0.040), visceral metastasis(P=0.018), postoperative radiotherapy(P=0.027) and targeted therapy(P=0.018) were significantly associated with the survival time after surgery in the univariate analysis. The surgical effect in tumor resection group was better than palliative decompression group, and there was no significant difference in the multivariate analysis. Conclusions: Multidisciplinary therapy after surgery including, radiotherapy and targeted therapy could prolong the survival for patients with spinal metastasis of renal clear cell carcinoma. Surgical treatment could relieve pain, preserve nerve function, and therefore improve the quality of life.