Surgery in renal cell carcinoma patients with lung and bronchus metastasis

With considerable interest, we read the article published by Lin et al. (1), who studied whether renal cell carcinoma (RCC) patients with lung and bronchus (LBM) metastasis could benefit from surgical intervention. This particular topic is an important clinical issue. As such, there are a few points that we would like to address.

• The patient’s baseline characteristics did not include the tumor stage (T stage), as shown in Table 1. The T stage is associated with overall survival in metastatic renal cell carcinoma patients (mRCC) (2).
• The author stated in the Introduction section that “In National Comprehensive Cancer Network clinical practice guidelines of kidney cancer, RCC with LBM is classified as stage IV in which nephrectomy and resection of lung metastases are first-line therapy”. It would be more worthwhile to stratify patients according to the type of surgical intervention that they received; in this way, readers can easily see which treatment method produces better clinical outcomes in mRCC patients with LBM.
• Some of the patients included in the analysis received radiotherapy or chemotherapy in both the surgical intervention group and the non-surgical group. Treatment with radiotherapy and chemotherapy should be taken into consideration since prior studies have demonstrated that both radiotherapy and chemotherapy have an impact on the clinical outcomes in patients with mRCC (3-5).
• Gender is unbalanced in Table 1 after propensity score matching. This piece of data is important because a prior study has shown that males have better overall survival rates and cancer-specific survival rates than females in mRCC patients (2).

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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References

1. Lin S, Zheng Y, Qin Z, et al. Surgical intervention in renal cell carcinoma patients with lung and bronchus metastasis is associated with longer survival time: a population-based analysis. Ann Transl Med 2019;7:323. [Crossref] [PubMed]
2. Abdel-Rahman O. Clinical correlates and prognostic value of different metastatic sites in metastatic renal cell carcinoma. Future Oncol 2017. [Epub ahead of print]. [Crossref] [PubMed]
3. He L, Liu Y, Han H, et al. Survival Outcomes After Adding Stereotactic Body Radiotherapy to Metastatic Renal Cell Carcinoma Patients Treated With Tyrosine Kinase Inhibitors. Am J Clin Oncol 2020;43:58-63. [Crossref] [PubMed]
4. Xu Z, Li X, Qi F, et al. A new strategy for the treatment of sorafenib-refractory metastatic renal cell carcinoma in China: combination with intermittent chemotherapy. Transl Androl Urol 2019;8:339-45. [Crossref] [PubMed]
5. Stenman M, Sinclair G, Paavola P, et al. Overall survival after stereotactic radiotherapy or surgical metastasectomy in oligometastatic renal cell carcinoma patients treated at two Swedish centres 2005-2014. Radiother Oncol 2018;127:501-6. [Crossref] [PubMed]