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. 2020 Jun;38(6):604.e9-604.e17.
doi: 10.1016/j.urolonc.2020.02.029. Epub 2020 Apr 3.

Improved survival after cytoreductive nephrectomy for metastatic renal cell carcinoma in the contemporary immunotherapy era: An analysis of the National Cancer Database

Nirmish Singla  1 , Ryan C Hutchinson  2 , Rashed A Ghandour  2 , Yuval Freifeld  2 , Dong Fang  3 , Arthur I Sagalowsky  2 , Yair Lotan  2 , Aditya Bagrodia  2 , Vitaly Margulis  4 , Hans J Hammers  5 , Solomon L Woldu  6
Affiliations

Improved survival after cytoreductive nephrectomy for metastatic renal cell carcinoma in the contemporary immunotherapy era: An analysis of the National Cancer Database

Nirmish Singla et al. Urol Oncol. 2020 Jun.

Abstract

Objectives: Despite immune checkpoint inhibitor (ICI) approval for metastatic renal cell carcinoma (mRCC) in 2015, cytoreductive nephrectomy (CN) is guided by extrapolation from earlier classes of therapy. We evaluated survival outcomes, timing, and safety of combining CN with modern immunotherapy (IO) for mRCC.

Methods: From 96,329 renal cancer cases reported to the NCDB between 2015 and 2016, we analyzed 391 surgical candidates diagnosed with clear cell mRCC treated with IO ± CN and no other systemic therapies. Primary outcome was overall survival (OS) stratified by the performance of CN (CN + IO vs. IO alone). Secondary outcomes included OS stratified by the timing of CN, pathologic findings, and perioperative outcomes.

Results: Of 391 patients, 221 (56.5%) received CN + IO and 170 (43.5%) received IO only. Across a median follow-up of 14.7 months, patients who underwent CN + IO had superior OS (median NR vs. 11.6 months; hazard ratio 0.23, P < 0.001), which was upheld on multivariable analyses. IO before CN resulted in lower pT stage, grade, tumor size, and lymphovascular invasion rates compared to upfront CN. Two of 20 patients (10%) undergoing CN post-IO achieved complete pathologic response in the primary tumor (pT0). There were no positive surgical margins, 30-day readmissions, or prolonged length of stay in patients undergoing delayed CN.

Conclusion: Using a large, national, registry-based cohort, we provide the first report of survival outcomes in mRCC patients treated with CN combined with modern IO. Our findings support an oncologic role for CN in the ICI era and provide preliminary evidence regarding the timing and safety of CN relative to IO administration.

Keywords: Cytoreductive nephrectomy; Immunotherapy; Metastatic renal cell carcinoma; Survival.

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Conflict of interest statement

CONFLICTS OF INTEREST

None.

Figures

Figure 1.
Figure 1.
Kaplan-Meier analysis of OS in mRCC patients treated with IO, stratified by receipt of CN. Median OS for CN+IO was not reached, versus 11.6 months (95% CI 8.5–14.7 months) for IO alone (HR 0.23 [95% CI 0.15–0.37], log-rank p<0.001).
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References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30. - PubMed
    1. Howlader NNA, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975–2014, National Cancer Institute; Bethesda, MD, https://seer.cancer.gov/csr/1975_2014/, based on November 2016 SEER data submission, posted to the SEER web site, April 2017.
    1. Heng DY, Xie W, Regan MM, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol. 2009;27(34):5794–5799. - PubMed
    1. Mekhail TM, Abou-Jawde RM, Boumerhi G, et al. Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma. J Clin Oncol. 2005;23(4):832–841. - PubMed
    1. MotzerRJ Hutson TE, Tomczak P, et al. Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol. 2009;27(22):3584–3590. - PMC - PubMed

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