Patterns of Relapse and Implications for Post-Nephrectomy Surveillance in Patients with High Risk Nonclear Cell Renal Cell Carcinoma: Subgroup Analysis of the Phase 3 ECOG-ACRIN E2805 Trial

Narayan, Vivek; Puligandla, Mäneka; Haas, Naomi B.; Subramanian, Pearl; DiPaola, Robert S.; Uzzo, Robert G.

doi:10.1016/j.juro.2018.08.041

Cited by 8 publications

(7 citation statements)

References 17 publications

(30 reference statements)

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“…This association has not been described in patients with sRCC before. Interestingly, a similar pattern has been reported between primary tumor histology and the location of asynchronous metastases after nephrectomy for localized RCC 25 . Potentially, patients with non-clear cell histology may benefit from lymph node dissection at the time of surgery.…”

Section: Discussionsupporting

confidence: 71%

The Role of Cytoreductive Nephrectomy for Sarcomatoid Renal Cell Carcinoma: A 29-Year Institutional Experience

Silagy

Blum

DiNatale

et al. 2020

Urology

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Objective: To assess which patients respond best following cytoreductive nephrectomy for renal cell carcinoma (RCC) with sarcomatoid dedifferentiation (sRCC) and whether outcomes are improving over time. Methods:We identified 562 patients with metastatic RCC treated between 1989-2018 with cytoreductive nephrectomy. We reviewed baseline clinical and pathological characteristics, including the presence of sRCC, and metastatic sites at time of nephrectomy. The primary study endpoint was overall survival (OS). Univariate and multivariate Cox-regression analyses were used to identify significant predictors of OS. Results:The study cohort had 192 sRCC patients, with a median age of 59 years. Frequently involved metastatic locations were lung (n=115), retroperitoneal nodes (n=63) and axial skeleton (n=43). Lung metastasis were more prevalent in clear cell histology (p=0.0017) whereas nodal involvement was associated with non-clear cell subtypes (p=0.0064).Median follow-up was 14 months. Estimated 2-and 5-year OS were 34.1% and 14.8%, respectively. On multivariate analysis, metastases to the liver (HR=1.64; 95% CI 1.02-2.63; p=0.04), lung (HR=1.50; 95% CI 1.05-2.14; p=0.03), retroperitoneal nodes (HR=1.52; 95% CI 1.03-2.25; p=0.04) and non-clear cell histology (HR=1.61; 95% CI 1.10-2.35; p=0.01) were associated with worse OS in the sRCC cohort. Conclusion:OS after cytoreductive nephrectomy for sRCC and non-sRCC is improving over time. In patients with sRCC, presentations with unifocal metastasis not involving the liver or lung,

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Section: Discussionsupporting

confidence: 71%

The Role of Cytoreductive Nephrectomy for Sarcomatoid Renal Cell Carcinoma: A 29-Year Institutional Experience

Silagy

Blum

DiNatale

et al. 2020

Urology

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“…Nevertheless, we were able to demonstrate that the lymphatic spread is more common among high-risk patients, as defined by the UISS, than among low-risk patients. These results are supported by a recent study by Narayan et al [29], a post hoc retrospective analysis of patients with non-ccRCC enrolled in a large randomised trial of adjuvant antiangiogenic therapy for high-risk (!T1b grade 3-4 N0) RCC (phase III ASSURE trial). Results showed that 39% of non-ccRCC patients in this cohort developed the first recurrence within the retroperitoneal lymph nodes, indicating that patients with high-risk non-ccRCC indeed appear to demonstrate this distinct pattern of recurrence.…”

Section: 6%supporting

confidence: 68%

The Impact of Histological Subtype on the Incidence, Timing, and Patterns of Recurrence in Patients with Renal Cell Carcinoma After Surgery—Results from RECUR Consortium

Abu-Ghanem

Powles

Capitanio

et al. 2021

European Urology Oncology

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Background: Current follow-up strategies for patients with renal cell carcinoma (RCC) after curative surgery rely mainly on risk models and the treatment delivered, regardless of the histological subtype. Objective: To determine the impact of RCC histological subtype on recurrence and to examine the incidence, pattern, and timing of recurrences to improve follow-up recommendations. Design, setting, and participants: This study included consecutive patients treated surgically with curative intention (ie, radical and partial nephrectomy) for nonmetastatic RCC (cT1-4, M0) between January 2006 and December 2011 across 15 centres from 10 countries, as part of the euRopEan association of urology renal cell carcinoma guidelines panel Collaborative multicenter consortium for the studies of follow-Up and recurrence patterns in Radically treated renal cell carcinoma patients (RECUR) database project. Outcome measurements and statistical analysis: The impact of histological subtype (ie, clear cell RCC [ccRCC], papillary RCC [pRCC], and chromophobe RCC [chRCC]) on recurrence-free survival (RFS) was assessed via univariate and multivariate analyses, adjusting for potential interactions with important variables

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“…Non‐clear cell RCC was more likely to develop abdominal recurrence. 13 Since the efficacy of TKIs in non‐clear cell RCC is disappointing (ORR 5%–18%), 14 , 15 it is natural that the addition of local therapy had the advantage over systemic therapy alone in our non‐clear cell RCC patients. Of note, local therapy improved PFS in patients with time to recurrence <14.6 months, but no improvement of OS was found.…”

Section: Discussionmentioning

confidence: 99%

Locoregional recurrence after nephrectomy for localized renal cell carcinoma: Feasibility and outcomes of different treatment modalities

Liu

Zhang

et al. 2022

Cancer Medicine

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Background Locoregional recurrence after nephrectomy for localized renal cell carcinoma (RCC) is rare with diverse manifestations. The selection criteria and efficacy of different treatments are unanswered. The objective was to compare different treatment modalities and present data on stereotactic body radiotherapy (SBRT) for recurrent RCC. Materials and Methods Patients with locoregional recurrence after nephrectomy without distant metastasis were identified from institutional big data intelligence platform between 2001 and 2020. Patients receiving local therapy (surgery or SBRT) or systemic therapy alone (targeted therapy or PD‐1 inhibitors) were divided into two groups. Progression‐free survival (PFS) and overall survival (OS) were analyzed using Kaplan–Meier method, Cox regression model. Patients were matched with propensity score matching. Results Among 106 patients, 33 (31.1%) received systemic therapy alone and 73 (68.9%) received local therapy. Local therapy was surgery in 34 patients (32.1%) and SBRT in 39 (36.8%) patients. Patients treated with systemic therapy alone had more non‐clear cell type (p = 0.044), more advanced T stage (p = 0.006), higher number (p = 0.043) but smaller size of lesions (p = 0.042). Patients receiving local therapy had significantly longer PFS than systemic therapy (19.7 vs. 7.5 months, p = 0.001). After matching, the PFS in the local therapy group remained higher (23.9 vs. 7.5 months, p = 0.001). The 2‐year OS of the local therapy group and systemic therapy group was 91.6% and 71.8%, respectively (p = 0.084). Local therapy was associated with better PFS (HR 0.37; p = 0.0003) and OS (HR 0.23; p = 0.002) in multivariate analysis. Grade 2 or higher toxicities related to local therapy occurred in nine patients. Conclusions Local therapy could delay disease progression compared with systemic therapy alone. SBRT is safe and effective for locally recurrent RCC.

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Patterns of Relapse and Implications for Post-Nephrectomy Surveillance in Patients with High Risk Nonclear Cell Renal Cell Carcinoma: Subgroup Analysis of the Phase 3 ECOG-ACRIN E2805 Trial

Abstract: Non-ccRCC may exhibit a distinct pattern of relapse when compared to ccRCC. Our findings emphasize the importance of cross-sectional, long-term imaging for patients with high-risk resected non-ccRCC.

Cited by 8 publications

References 17 publications

The Role of Cytoreductive Nephrectomy for Sarcomatoid Renal Cell Carcinoma: A 29-Year Institutional Experience

The Role of Cytoreductive Nephrectomy for Sarcomatoid Renal Cell Carcinoma: A 29-Year Institutional Experience

The Impact of Histological Subtype on the Incidence, Timing, and Patterns of Recurrence in Patients with Renal Cell Carcinoma After Surgery—Results from RECUR Consortium

Locoregional recurrence after nephrectomy for localized renal cell carcinoma: Feasibility and outcomes of different treatment modalities

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