Prognostic evaluation of transcatheter arterial embolization for unresectable renal cell carcinoma with distant metastasis

Objective To evaluate the efficacy of transcatheter arterial embolization ( TAE) in patients with unresectable renal cell carcinoma (RCC) and distant m etastasis at the time of diagnosis. Patients and methods The study included 54 patients with histologically def ined RCC (by biopsy in 28 and autopsy in 26) who were unable to undergo nep hrectomy mainly because their performance status was poor (score greater th an or equal to2). The patients were classified into two groups; 24 patients who underwent TAE with ethanol and 30 patients who did not. The two groups were compared for several clinical factors, mainly focusing on the prognos is. Results There were no significant differences in the clinical factors, incl uding performance status, tumour diameter, vascular invasion, lymph node in volvement, adjuvant therapy, metastatic organs or the number of metastases between the groups. However, the proportion of patients with para-neoplasti c signs in those undergoing TAE was greater than that in those not, and the difference was significant (chi squared 0.35, P<0.05). The median survival of the two groups was 229 days (TAE) and 116 days (no TAE). The 1-, 2- and 3-year survival rates in the TAE group were 29%, 15% and 10%, respectively , and in those not undergoing TAE were 13%, 7% and 3%, respectively. Those undergoing TAE had a significantly better prognosis than those who did not (P=0.019). The adverse effects in patients undergoing TAE with ethanol incl uded fever, back pain on the affected side, nausea and vomiting, but all th e patients recovered from these adverse effects. Conclusion TAE with ethanol is a safe and effective treatment for patients with unresectable disseminated RCC and a poor performance status; TAE with ethanol not only induces ablation of the primary tumour, but also prolongs survival.