The role of cytoreductive nephrectomy in metastatic clear cell carcinoma: Analisys of an other-cause mortality matched population from the contemporary immunotherapy era
Recommended Citation
Finati M, Cirulli GO, Chiarelli G, Tinsley S, Morrison C, Davis M, Arora S, Etta P, Butaney M, Sood A, Buffi NM, Lughezzani G, Salonia A, Briganti A, Montorsi F, Bettocchi C, Carrieri G, Rogers CG, Abdollah F. The role of cytoreductive nephrectomy in metastatic clear cell carcinoma: Analisys of an other-cause mortality matched population from the contemporary immunotherapy era. Eur Urol 2024; 85:S1866-S1866.
Document Type
Conference Proceeding
Publication Date
3-1-2024
Publication Title
Eur Urol
Abstract
Introduction & Objectives: In the recent randomized CARMENA trial, performing cytoreductive nephrectomy (CN) did not improve overall survival in metastatic renal cell carcinoma (RCC) patients treated with Sunitinib. However, this trial raised concerns about possible selection bias of patients with higher metastatic burden and consequent poor prognosis. Conversely, population-based studies showed how patients referred to CN usually have better health status, which reflects in lower risk for any cause of death. We aimed to evaluate the role of CN on cancer-specific mortality (CSM) within an immunotherapy-era cohort of metastatic RCC patients matched for their other-cause mortality (OCM) risk. Materials & Methods: The Surveillance, Epidemiology and End Results Registry was queried to identify > 18 years patients diagnosed with metastatic RCC, between 2010 and 2017. We included only patients treated with immunotherapy. A Cox regression model including treatment type (CN versus no surgery of the primary site) was used to calculate the other-cause mortality (OCM) risk. Therefore, a 1:1 propensity score match was used to create a cohort of metastatic RCC patients, treated or not with CN, having the same OCM risk. Cumulative incidence curves were depicted to assess CSM and OCM, while Fine-Gray regression tested the impact of CN on CSM. Patients were further stratified according to number of metastasis (1, 2 or more than 2 sites) and the same aforementioned analyses were repeated for these sub-cohorts. Results: We identified 3138 patients with metastatic RCC treated with immunotherapy, of whom 1597 (51%) were treated with CN. In the unmatched cohort, 3-years CSM and OCM rates were 80.8% and 15.5% for non-surgery arm respectively, versus 54.3% and 8.4% for CN patients (all p<0.001). Our Cox Regression model matching yielded to 1662 patients equally distributed, with no difference in OCM rate (11.7% vs 10.8%, p=0.8). In the matched cohort, the 3-years CSM was 54.1% for CN patients vs 80.3% in non-surgery arm (p<0.001). At multivariable analysis, patients who did not receive surgery had 1.79-fold higher CSM risk, when compared with those who underwent CN (95% CI: 1.56-2.06, p<0.001). When stratifying patients for metastases sites, patients who did not undergo CN had higher CSM rates when they harboured metastasis in 1 (84.5% vs 70.0%) or 2 sites (87.8% vs 73.4%, all p<0.001). Conversely, no difference in CSM rate where observed for patients with 3 or more metastases sites, regardless of nephrectomy receipt (89.1% vs 86.8%, p=0.06). Conclusions: We evaluate the role of CN in a immunotherapy-era cohort of metastatic RCC, using OCM risk matching as a proxy of similar health status. In this setting, performing CN yielded a survival advantage in patients with low-to intermediate metastatic burden. Conversely, CN did not CSM for patients with widespread metastases.
Volume
85
First Page
S1866
Last Page
S1866
