Survival Analyses of Patients With Metastatic Renal Cancer Treated With Targeted Therapy With or Without Cytoreductive Nephrectomy: A National Cancer Data Base Study

Abstract

Purpose The role of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) has become unclear since the introduction of targeted therapies (TT). We sought to evaluate contemporary utilization rates of CN and to examine the survival benefit of CN compared with non-CN patients treated with TT. Methods We used the National Cancer Data Base to identify patients with clinical mRCC treated with TT between 2006 and 2013. The intervention of interest was CN. Multivariable logistic regression predicting receipt of CN was performed. Overall survival (OS) was examined using Cox regression models and incremental survival analyses were performed. Sensitivity analyses using propensity scores were conducted. Results Of 15,390 patients treated with TT, 5,374 (35%) underwent CN between 2006 and 2013. Patients who were younger, privately insured, treated at an academic center, and had lower tumor stage and cN0 disease were more likely to undergo CN. The median OS of CN versus non-CN patients was 17.1 (95% CI, 16.3 to 18.0 months) versus 7.7 months (95% CI, 7.4 to 7.9 months; P < .001). In sensitivity analyses using propensity scores adjustment in addition to other available covariates, CN patients had a lower risk of any death (hazard ratio, 0.45; 95% CI, 0.40 to 0.50; P < .001). The survival benefit of CN was +0.7 and +3.6 months in patients who survived ≤ 6 and ≤ 24 months, respectively, versus no CN. Conclusion CN is performed in three of 10 patients with mRCC who are receiving TT. Several patient and sociodemographic characteristics were associated with receipt of CN. When feasible, CN may offer an OS benefit when combined with TT.

Effect of renal embolization in patients with synchronous metastatic renal cell carcinoma: A retrospective comparison of cytoreductive nephrectomy and systemic medical therapy

“…These include a retrospective design, short follow-up observation, small number of cases and between-group variation in baseline characteristics, including overall tumor burden, such as metastatic lesions and metastasectomy. Our median PFS of 4.4 months and OS of 10.6 months for all patients were comparable to previously reported survival rates for IT and TT therapy [2,3,5,8]. As such, we deem our study to be clinically meaningful in comparing PFS and OS for CN, RE and NT interventions among patients treated using either systemic IT or TT as a first-line therapy, and by stratifying our analysis for risk, classified using the Heng and MSKCC criteria.…”

“…those having low and intermediate risk for survival, large primary tumors, limited metastatic burden, and overall good functional status [4,5]. However, in the absence of randomized clinical trials, controversy persists regarding the prognostic benefits of CN in the era of TT.…”

Treatment of Metastatic Renal Cell Carcinoma

“…I v době cílené terapie a imunoterapie má své postavení provedení cytoredukční nefrektomie u pacientů s mRCC. Nemocní, kteří absolvovali cytoredukční nefrektomii, měli delší OS než pacienti bez nefrektomie (17,1 vs. 7,7 měsíce; p < 0,001) [15]. Obecně lze doporučit provedení cytoredukční nefrektomie u pacientů v dobrém výkonnostním stavu a s méně rozsáhlým metastatickým postižením [16].…”

High competing risks minimize real-world utility of adjuvant targeted therapy in renal cell carcinoma: A population-based analysis

“…Of note, while the benefit of cytoreductive nephrectomy was established in the cytokine era, [9] many retrospective studies have attempted to address the role of cytoreductive nephrectomy in the TT era [8,11,25]. In this study, in patients with cM1 disease who received TT, cytoreductive surgery significantly reduced CSM, suggesting continued benefit.…”

“…Utilized in patients with de novo metastatic RCC or patients with metastatic progression following primary surgical management, they have been demonstrated to extend progression-free survival by 3-8 months in patients with clear-cell histology [1,2,6,7]. Their introduction has even called into question the oncologic value of cytoreductive nephrectomy, which was first established in the cytokine era [8][9][10][11].…”