Survival of patients receiving systematic therapy for metachronous or synchronous metastatic renal cell carcinoma: a retrospective analysis

Abstract

Background The differences in progression-free survival (PFS) and cancer-specific survival (CSS) of metastatic renal cell carcinoma (mRCC) patients according to treatment, type of metastasis, and Heng criteria risk are unclear. In this study, we compared survival according to various such parameters. Methods Between 2000 to 2014, 214 mRCC patients, of whom 171 (79.9%) were intermediate-risk and 43 (20.1%) were poor-risk, were retrospectively selected; 126 (58.9%) patients were treated with immunotherapy (IT) and 88 (41.1%) with targeted therapy (TT). Moreover, 144 patients had synchronous mRCCs (67.3%, SM) and 70 had metachronous mRCCs (32.7%, MM). The Kaplan-Meier method and log-rank test were used to compare progression-free survival (PFS) and CSS. Results During a median 4.2 (1.0–70.4) months of systemic treatment and 98.3 (4.8–147.6) months of follow-up, the median PFS and CSS were 4.7 (95% confidence interval [CI]: 3.8–5.5) and 13.8 (95% CI, 9.8–18.3) months, respectively. The PFS and CSS were significantly better in the MM (5.9 and 21.3 months) and intermediate-risk groups (5.2 and 18.3 months) than those in the SM (4.4 and 9.6 months) and poor-risk groups (2.7 and 5.8 months), respectively ( p < 0.05). Further stratification showed that TT produced significantly better PFS than IT in intermediate-risk patients with SM and a treatment-free interval (TFI) < 1 year, and in those with MM with a TFI ≥1 year ( p < 0.05). There were no differences in survival outcomes according to various other subgroup stratifications ( p > 0.05). Conclusion Dividing patients into specific subcategories helps to better predict therapeutic outcomes. Electronic supplementary material The online version of this article (10.1186/s12885-019-5900-1) contains supplementary material, which is available to authorized users.

Comparison of prognostic factors that affect the survival of patients with metachronous and synchronous metastases of renal cell carcinoma

“…так, S.H. Kim et al (2019) изучали прогностические факторы у больных СМ и ММ и показали, что пациенты с СМ и неблагоприятным прогнозом по Heng имеют наименьшие показатели выживаемости, на которые влияет системная терапия и улучшает ВБП у пациентов с ММ промежуточного прогноза. При однофакторном анализе канцер-специфической выживаемости статистически значимыми прогностическими факторами являлись тип метастаза, гиперкальциемия, нейтрофилия, повышение лдГ и тромбоцитопения, при многофакторном -гиперкальциемия, нейтрофилия, повышение лдГ и тромбоцитопения.…”

“…При однофакторном анализе канцер-специфической выживаемости статистически значимыми прогностическими факторами являлись тип метастаза, гиперкальциемия, нейтрофилия, повышение лдГ и тромбоцитопения, при многофакторном -гиперкальциемия, нейтрофилия, повышение лдГ и тромбоцитопения. также авторы в своём исследовании отметили, что различия в оВ для СМ и ММ становятся статистически незначимыми при сравнении больных с неблагоприятным прогнозом по Heng [8]. S. Naito et al (2020) продемонстрировали на основании анализа пяти независимых прогностических факторов (стадия т, стадия N, наличие метастазов в головной мозг, уровень кальция в крови и соотношение нейтрофилов и лимфоцитов), что ни один из них не влияет на оВ при наличии ММ, и факторы риска различны для СМ и ММ [9].…”

Nephrectomy improves the survival of metastatic renal cell cancer patients with moderate to good performance status—results from a Finnish nation-wide population-based study from 2005 to 2010

“…These results correlated closely to those reported in our study. However, it must be noted that as our dataset consisted only of patients with primary (synchronous) mRCC, there may be a tendency towards more aggressive cancers, compared to datasets with both synchronous and metachronous mRCC [ 27 , 28 ].…”

Metastasis-directed therapy for oligometastatic urological tumours: still no second-hand news

“…However, currently a median OS up to 33 months has been reported [7]. Patients developing metachronous mRCC perform better than those presenting with synchronous mRCC [19].…”