Until now no conclusive data exist regarding the factors influencing long-term survival
after pulmonary resection of renal cell carcinoma metastases. The aim of the present
study, therefore, was to discover definitive prognostic factors for survival using
a large and homogeneous single center patient cohort.
Between 1980 and 2000, 105 patients, after curative resection of lung metastases from
renal cell carcinoma, were followed in this long-term study. These patients underwent
a total of 150 surgical procedures. Survival analysis was done using the Kaplan-Meier
method and the log-rank test. Multivariate analysis of prognostic factors was performed
using the Cox multivariate proportional hazard model.
Median survival after curative resection reached 43 months (range, 1 to 218 months).
Survival at 3, 5, and 10 years was 54%, 40%, and 33%, respectively. Univariate analysis
revealed that a complete resection, a less than 4-cm diameter of the metastases and
tumor-free lymph nodes at the time of primary operation, were highly significant dependent
prognostic factors (p < 0.001). These factors were also shown to be independent prognostic
factors as suggested by multivariate analysis (p < 0.05).
The size of the metastatic nodule, the completeness of pulmonary resection, and the
lymph node status at the time of nephrectomy are the most important prognostic factors
that influence survival after resection of pulmonary metastases. Recurrence of resectable
pulmonary metastases does not impair survival, thus favoring repeated resection in
patients with recurrent disease.