Studio osservazionale multicentrico retrospettivo sulle metastasi ossee da neoplasie del rene

Introduction Bone metastases are an emerging clinical problem in renal cancer patients probably related to survival increase. There are few data in literature about the natural history of bone disease in renal cancer and about the role of BPs in the treatment of bone disease from renal cancer. We report the preliminary data of a large Italian multicenter survey. Methods 357 renal cancer patients with evidence of bone metastases have been included in the study at the moment of abstract submission. All patients were died due to cancer at the moment of the study inclusion. Clinico-pathological data, data on survival and Skeletal Related Events (SRE) data and skeletal related therapies have been collected in a master data base and statistically analyzed. Results 253 males/104 females; median age: 63 (16-87); patients with bone metastases at the moment of renal cancer diagnosis: 31.4%; patients with single bone metastasis: 31.1%; lytic type: 77%, mixed: 14.6%, blastic: 7.6 %. Sites: spine (65.8%), pelvis (38.4%), long bones (31.6%), other (18.8%). Median VAS pain at diagnosis: 4 (0-9), maximum pain: 6 (0-10). Median time to bone metastases: 8 months (0-288) (all patients); 24 months (1-288) (patients without bone met at diagnosis). Patients with at least 1 SRE: 71.1%. Types of SREs: pathologic fracture (12.6%), radiotherapy (61.8%), spinal compression (7.6%), bone surgery (14.8%), hypercalcaemia (3.2%). Median number of SRE for patient: 1 (0-4). Median time to first SRE: 2 (0-72), to second SRE: 4 (0-113), to third SRE: 11 (1-108). Median survival after bone met diagnosis: 12 (1-178). Median survival after first SRE: 10 (0-144). Median survival in patients with at least one SRE: 14 (1-178); median survival in patients without SREs: 9 (0-62). As regard BPs a total of 168 patients received zoledronic acid (4 mg) via a 15-minute infusion every 4 weeks until performance status worsening or death. 162 patients have been analysed as control group. The median time to first SRE in the whole population was 2 mth (0-72). The median time to first SRE in the zoledronic treated patients was 3 mths (0-101) compared with 1 mth (0 - 25) in the control group (p < 0.05). The median survival after skeletal progression was 12 (1-178). The median survival in the zoledronic treated group was 15 mths (2-120) compared with 8 mths (1-178). (p <0.05). Only 5 cases of ONJ have been diagnosed. Conclusions The present survey is the largest descriptive study concerning the natural history of bone disease in renal cancer patients and a confirmation, in clinical practice scenario, of zoledronic acid activity in bone metastases from renal cancer patients