When it comes to kidney cancer, it is easy to think of death. When it comes to death, cancer patients will invariably think of one question: How long will I live? Death is the most serious result that can be caused by advanced cancer. We need to face death bravely and overcome it. In order to answer this question, today we introduce to you the common metastatic ways of kidney cancer and how to predict the survival time by metastatic sites. I. What are the ways of metastasis of renal cell carcinoma? 1.Direct spread: Kidney cancer can directly invade and penetrate the perinephric fascia to local spread and infiltrate adjacent tissues and organs, including spleen, pancreas, descending colon, transverse colon, small intestine and abdominal aorta around the left kidney, liver, duodenum, ascending colon and inferior vena cava around the right kidney, as well as the posterior muscles. The cancer thrombus in the inferior vena cava is a very special kind of local invasion, which can even continue upward all the way to the atrium. Usually, the cancer thrombus is continuous with the primary tumor of the kidney itself. 2.Lymphatic metastasis: kidney cancer cells can metastasize along the lymphatic vessels to the hilum and retroperitoneal lymph nodes, and a few can also metastasize to the mediastinum, pelvis and supraclavicular lymph nodes. 3.Hematogenous metastasis: Hematogenous metastasis is more common. Cancer cells invade blood vessels, most commonly lung metastasis, other common sites are bone, liver, brain, pleura, adrenal gland, etc. What are the treatment options for metastatic renal cell carcinoma? There are many treatment options for metastatic renal cell carcinoma. If nephrectomy is not performed, resection of the primary tumor of the kidney can be considered first, and then systemic systemic therapy including immunotherapy, new targeted therapy or clinical trials are needed. In the case of small solitary lesions in the lung or local recurrence in the kidney, metastasectomy may be considered. Radiotherapy and bisphosphonate therapy may be tried for severe painful bone metastases. Patients with brain metastases can try gamma knife treatment or whole cranial radiotherapy to reduce neurological symptoms. How to predict the survival time by the metastasis site? In the past, the average survival time of patients with metastatic renal cell carcinoma was 12 to 14 months. However, newer targeted drugs (the first-line drugs approved in China are Sotan and Doxorubicin) can extend this time to about 2 years. It is important to note that 2 years is the average time for a large sample size of patients, and this survival time may vary greatly from a few months to several years for each patient specifically. Here, we share our 8-year experience with sotan as well as doxorubicin-targeted therapy at our center, grouped by metastatic site. 1. Pulmonary metastases: 56% of patients come with pulmonary metastases, and this group has the best prognosis, with survival times of more than 40 months abounding. Brain metastases: 4-5% of patients come with brain metastases, and since the brain is functionally important to the human body, the prognosis for this group of patients is the worst, with an average survival time of 1 year. Liver metastases: 10% of patients have liver metastases. The prognosis of liver metastases is relatively poor and progresses faster, but it is better than brain metastases. 3.Adrenal, bone and lymph node metastasis: the prognosis of this part of patients is moderately optimistic and is between lung and liver. Of course, there are many other factors that can affect the prognosis of patients, such as longer survival time if the patients are old and strong, their tumors may not affect their lives immediately, and most of them can tolerate various related treatments. Patients with good psychological status tend to survive longer than those who are depressed after suffering a cancerous attack. Also, patients who respond better to treatment tend to survive longer. Therefore, one should build up confidence and actively treat in the face of tumor.