Prognostic factors for overall survival after lung metastasectomy in renal cell cancer patients: A systematic review and meta-analysis

Background: Pulmonary metastasis of Renal cell carcinomas (RCC) is usually considered as a systemic disease. However, some studies revealed potential survival benefits of pulmonary metastasectomies for such patients. The aim of this study was to conduct a systematic review and meta-analysis to assess the prognostic factors for pulmonary metastasectomy of RCC patients. Methods: An electronic search in MEDLINE, EMBASE, CENTRAL and Chinese BioMedical Literature Database (CBM) were conducted to identify eligible studies. We combined the hazard ratios (HRs) of the identified prognostic factors for overall survival of RCC patients after pulmonary metastasectomy from the eligible studies. Results: Sixteen studies with a total of 1447 patients were included in this meta-analysis. The pooled 1, 3, 5, 10-year overall survival rates for RCC patient after pulmonary metastasectomy were 84%, 59%, 43% and 20%, respectively. The poor prognostic factors were lymph node involvement (LNI) of primary RCC (HR 3.44, 95% confidence interval (CI) 1.78-6.67, P = 0.001), incomplete resection of metastases (HR 3.74, 95% CI 2.49-5.61, P = 0.000), multiple metastases (HR 1.55, 95% CI 1.18-2.03, P = 0.002), larger metastases (HR 1.45, 95% CI 1.26-1.66, P = 0.000), LNI of metastases (HR 3.06, 95% CI 1.52-6.19, P = 0.002), synchronous metastasis (HR 2.49, 95% CI 1.46-4.24, P = 0.001) and short disease free interval (DFI). Conclusions: Surgery may be a promising treatment for pulmonary metastases of RCC patients. A short DFI, LNI of primary RCC, incomplete resection of metastases, multiple metastases, larger metastases, LNI of metastases and synchronous metastasis are predictors of poor survival after pulmonary metastasectomy for RCC patients. (C) 2017 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.