INTRODUCTION: While renal cell carcinoma has a good prognosis in the early stage, the prognosis is poor in the advanced stage with metastasis. Because spinal metastasis is a major factor in ADL and QOL decline, timely intervention should be provided according to each patient’s condition. We report the surgical outcome for spinal metastasis of renal cell carcinoma in our institution.
METHODS: Twenty-six patients surgically treated for spinal metastases of renal cell carcinoma in our Cancer Board from 2013 to 2021 were prospectively evaluated. Spinal Instability Neoplastic Score (SINS), new Katagiri Score, surgical details, Performance Status (PS) and Barthel Index (BI) before and one month after surgery, pre- and postoperative radiation therapy (RT) and molecular target drug (MTD), postoperative complications, and survival were investigated.
RESULTS: The mean age was 71.9 years (21 men and 5 women). Median SINS was 11 (4–16), median new Katagiri score was 6 (2–8), and surgery was posterior decompression and fusion or total en bloc spondylectomy. Operation time was 188±64 minutes, and the estimated blood loss was 413±524 ml. Median PS improved from 3 preoperatively to 2 at 1 month postoperatively; 14 patients improved, 10 remained unchanged, and 2 deteriorated. BI improved from 59.4±31.9 preoperatively to 79.2±26.2 postoperatively (P<0.01). Eight patients received RT and 12 received MTD preoperatively, and 15 received RT and 20 received MTD postoperatively. MTD caused adverse events in 9 patients which resulted in discontinuation or dose reduction. Surgical site infection was found in 4 patients, and reoperation due to rod breakage or tumor growth was observed in 5. Survival was shorter than 3 months in 6 patients, shorter than 1 year in 4, and longer than 1 year in 16. Median survival was 461 days; 611 days in those who received postoperative MTD and 33 days in those who did not (P=0.01). All 6 patients whose survival were shorter than 3 months did not receive MTD.
DISCUSSION: Surgical treatment for spinal metastasis of renal cell carcinoma improved patients’ ADL and allowed to start or continue MTD therapy, which directly affected their survival. It is important to perform surgery for spinal metastases of renal cell carcinoma in a timely manner to improve ADL and lead to MTD therapy.