Complete metastasectomy in renal cell carcinoma: a propensity-score matched by the International Metastatic RCC Database Consortium prognostic model

Abstract

Introduction: We evaluated overall survival (OS) benefit of complete metastasectomy (CM) in metastatic renal cell carcinoma (mRCC) using a propensity score-matched (PSM) analysis to balance groups by age, gender and by the International Metastatic RCC Database Consortium prognostic model (IMDC). Methods: We included patients (pts) treated at the AC Camargo Cancer Center between 2007 and 2016. Pairs were matched by age, gender and IMDC. Kaplan-Meier survival estimates and Cox proportional hazard models were used to evaluate OS on CM and no-CM group. Results: We found 116 pts with clear cell mRCC. After PSM, the number was reduced to 74 (37 CM, 37 no-CM). The median OS for CM and no-CM was 98.3 months and 40.5 months, respectively (hazard ratio 0.24 95%CI 0.11-0.53 p < 0.001). The OS benefit of CM was confirmed on favourable and intermediate IMDC but was absent on poor IMDC. The CM group received less systemic therapy than the no-CM group. Ten pts in the CM group still have no evidence of disease (NED). Conclusion: After matching for age, gender and IMDC, we found CM impacts on OS and also diminishes the need for systemic treatment. Survival benefit was confirmed for favourable/intermediate IMDC but not for the poor IMDC prognostic model. Further studies correlating IMDC and metastasectomy are needed to guide clinical decision-making.

Metastatic Lesion of the Tibia from Renal Cell Carcinoma

“…Alt et al demonstrated that complete surgical resection of multiple RCC metastases was associated with a prolonged median cancer specific survival (CSS) to 4.8 years and, in fact, significantly improved the 5-year CSS rate (49.4%) compared with the rate among patients who did not undergo complete metastasectomy (13.9%) [ 17 ]. This benefit of metastatic resection has been confirmed by many other authors [ 18 – 20 ]. Therefore, wide resection with curative intent seems to be the primary approach to solitary or oligometastatic bone metastasis [ 13 ].…”

Role of metastasectomy in the management of renal cell carcinoma

“…Several studies demonstrated that certain patient populations had a lack of clinical improvement with metastasectomy for mRCC. Fares et al compared 37 MTX patients with 37 PSM non-MTX patients and found that the OS benefit of MTX was absent in patients with poor International Metastatic RCC Database Consortium (IMDC) risk stratification (33). Similarly, while Wu et al demonstrated a significant decrease in CSM overall, a sub-analysis revealed that only IMDC favorable-risk patients benefitted from MTX, whereas no significant difference was observed for intermediate and high-risk patients (24).…”

“…Both models have been externally validated and are effective in predicting outcomes for mRCC patients (88)(89)(90)(91). Multiple studies that have already been discussed in this text have demonstrated beneficial outcomes for mRCC patients with favorable-risk grouping in the MSKCC and IMDC models who undergo MTX, while patients with poor-risk stratification may fail to benefit from MTX (33,68,79,81)…”

“…Additionally, use of the risk stratification tools has been shown to be an effective way to determine the prognosis of patients with mRCC, and this data is then extrapolated to determine which patients may be more fit for surgery. Multiple studies have demonstrated that patients with favorable-risk grouping in the MSKCC and IMDC models are more likely to benefit from metastasectomy, while patients with poor-risk stratification may not benefit from surgery (33,68,79,81). The risk stratification tools in combination with various prognostic factors should be taken together when deciding if a patient would likely benefit from a metastasectomy.…”

Metastasectomy in kidney cancer: current indications and treatment approaches

“…Utilization of MTS is increasing, with rates increasing from 24.9% in 2006 to 31.4% in 2013 [11]. Since 2017 alone, eight retrospective studies have reexamined survival benefits of complete MTS (which surgically removes all gross metastases) in the treatment of mRCC, compared to incomplete or no-MTS [11][12][13][14][15][16][17][18][19] (Table 1). To evaluate the effect of complete MTS in the era of TT and ICI availability, Lyon et al assessed the likelihood of death from RCC in 403 patients.…”