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Page 4 of 12 Feuer et al. J Cancer Metastasis Treat 2021;7:68 https://dx.doi.org/10.20517/2394-4722.2021.164

Table 1. Summary of metastasectomy outcomes by metastatic site
Site 5-year OS Favorable features Unfavorable features
Lung [13-17] 39.9%-62.5% • DFI > 23 months • Age > 70
• < 3 metastases • Higher primary tumor stage/grade
• Small volume metastases (< 4 cc)
Bone [18-25] 11%-48% • Solitary metastases • Sarcomatoid differentiation
• Bone-only metastases • Concurrent non-bone metastases
• Clear-cell histology • Alkaline phosphatase > 1.5× the upper limit of normal
• CRP increase by > 0.3 mg/dL
• Pelvic metastases
[26-29] [29]
Liver 43%-62% (29% 2-year OS) • Metachronous metastases • Synchronous metastases
• *Solitary metastases • Eastern Cooperative Oncology Group score > 0
• High-grade histopathology
[30]
Brain 8.5% • NA • NA
*Noted to be beneficial in one study, no benefit in another. DFI: Disease free interval; CRP: C-reactive protein; OS: overall survival; NA: not
applicable.

A recent descriptive study demonstrated that men were four times more likely to harbor bone metastases.
Lesions had a predilection for axial bone and the incidence of severe events, including pathologic fracture,
was nearly 55%. Shorter time to bone metastasis, older age, multiorgan metastases, and carbonic anhydrase
expression loss were associated with poor prognosis. Huang et al. noted a median overall survival of 45
[18]
months for patients with favorable risk factors and 32 months for patients who were deemed unfavorable
risk.

[19]
Kollender et al. retrospectively analyzed 45 patients with solitary bone metastases and either intractable
pain or impending/current pathologic fracture who underwent surgical intervention. The authors noted
significant pain relief and good functional outcomes in approximately 90% of patients. Overall, half of the
patients survived more than 2 years, and 38% survived more than 3 years .
[19]
Higuchi et al. evaluated survival in 58 patients who underwent surgical intervention for either solitary or
[20]
multiple bone metastases at a single institution. Amongst the cohort, metastases were noted in the spine in
33 patients, in the appendicular skeleton in 10 patients, in the pelvis in 8 patients, in the thoracic bones in
four patients, and in soft tissue in 3 patients. Forty-six patients underwent metastasectomy, and 12 patients
underwent curettage. The authors noted an 89% overall survival at 1 year, 62% overall survival at 5 years,
and 48% overall survival at 10 years. The median overall survival for patients undergoing metastasectomy
was 127 months, and for curettage was 54 months. Of note, pelvic metastases were associated with shorter
[20]
median overall survival .

[21]
A study by Lin et al. retrospectively assessed 295 consecutive patients with bone metastases treated at a
single institution. Surgical interventions included curettage, en bloc resection, closed nailing, or amputation.
The authors noted an overall survival of 47% and 11% at 1 and 5 years, respectively. They reported that
patients with solitary metastases had the most favorable outcomes, and that patients with bone-only
metastases had a favorable prognosis relative to patients with additional extraosseous metastases.
Furthermore, clear-cell histology was associated with an improved prognosis. Notably, 5% of patients died
within 30 days of surgery .
[21]
Ptashnikov et al. recently conducted a retrospective review of 100 patients with spinal mRCC.
[22]
Metastasectomy was performed in 39 cases while 61 patients underwent decompression procedures with
stabilization-only, analyzing pain, neurologic status, overall and progression-free survival. Of these patients,