Management of pancreatic metastases from renal cell carcinoma.

e16526 Background: The pancreas is a rare site of metastases, although metastatic renal cell carcinoma (mRCC) is the most commonly reported secondary tumor. It has been suggested that patients with pancreatic metastases (PM) have improved survival outcomes and more angiogenic driven biology than other metastatic sites although there is limited data in the literature concerning the management of these patients. The purpose of this study is to disclose the characterization and treatment outcomes of pancreatic metastases from RCC. Methods: Patients with recurrent RCC from previous radical surgery for localized tumor, presenting with < 3 metastatic lesions, treated at our hospital between 2005 and 2025, were retrospectively reviewed and statistically analyzed. Progression-free survival (PFS) and Overall Survival (OS) was assessed using Cox regression analysis comparing different therapeutic modalities. Results: 96 mRCC patients were identified, median age of 63 years. Twelve patients (12.5 %) within the cohort had pancreatic only metastases and underwent pancreatectomy followed by systemic therapy. The median time from index nephrectomy to pancreatectomy was 6 years. Median follow-up was 69.3 months. Patients with PM had a significantly greater interval from primary diagnosis to the date of first systemic treatment as compared to those without (median: 38 vs 9 months) (p,0.002). As expected, patients with PM in the overall population had improved OS from the primary diagnosis compared to non-PM 65 vs 29 months (HR 0.56, p,0.02). Similarly, PFS from diagnosis was significantly prolonged in those with PM (66 vs 26 months, HR 0.44, p,0.01). Post-pancreatectomy disease specific survival at 2- and 4-years were 87% and 76%. Interestingly, PM only patients who received either molecularly targeted therapies (single agent) or combinations with immunotherapy, have a significant improvement in survival compared to those without PM. Conclusions: The pancreas is frequently the only metastatic site from RCC with less aggressive features that may result in a more favorable patient prognosis. The study highlights the importance of multidisciplinary approach for patients with metachronous oligometastatic RCC. The OS period of these patients is long and both surgical and medical treatment resulted in good outcomes.