Prognostic Factors for Survival in Patients Undergoing Surveillance After Cytoreductive Nephrectomy

Overview

Journal J Urol

Publisher Wolters Kluwer

Specialty Urology

Date 2023 May 11

PMID 37167628

Authors

Stephen W Reese

Sari Khaleel

Andrew Silagy

Amy Xie

Lennert Eismann

Katiana Vazquez-Rivera

Arnold Oparanozie

Sujata Patil

Jonathan Coleman

Robert Motzer

Ritesh R Kotecha

Paul Russo

Martin H Voss

A Ari Hakimi

Affiliations

Soon will be listed here.

Abstract

Purpose: The clinical course of patients being placed on surveillance in a cohort of systemic therapy-naïve patients who undergo cytoreductive nephrectomy is not well documented. Thus, we evaluated the clinical course of patients placed on surveillance following cytoreductive nephrectomy and identified predictors of survival.

Materials And Methods: In this large single-institution study, we retrospectively analyzed metastatic renal cell carcinoma patients who underwent cytoreductive nephrectomy followed by surveillance. Predictors of survival were evaluated using the Kaplan-Meier method with a log-rank test. Patients were risk stratified based on IMDC (International mRCC Database Consortium) and number of metastatic sites (Rini score), with IMDC score ≤1 and ≤2 metastatic organ sites considered favorable risk. Primary end point was systemic therapy-free survival. Secondary end points included intervention-free survival, cancer-specific survival, and overall survival.

Results: Median systemic therapy-free survival was 23.6 months (95% CI: 15.1-40.6), intervention-free survival was 11.8 months (95% CI: 8.0-18.4), cancer-specific survival was 54.2 months (95% CI: 46.2-71.4), and overall survival 52.4 months (95% CI: 40.3-66.8). Favorable-risk patients compared to unfavorable-risk patients had longer systemic therapy-free survival (50.6 vs 11.1 months, < .01), survival (25.2 vs 7.3, < .01), and cancer-specific survival (71.4 vs 46.2 months, = .02).

Conclusions: Using risk stratification based on IMDC and number of metastatic sites, surveillance in favorable-risk patients can be utilized for a period without the initiation of systemic therapy. This approach can delay patients' exposure to the side effects of systemic therapy.

References

Okita K, Hatakeyama S, Naito S, Numakura K, Kato R, Koguchi T . External validation of the REMARCC model for the selection of cytoreductive nephrectomy in patients with primary metastatic renal cell carcinoma: A multicenter retrospective study. Urol Oncol. 2021; 39(12):836.e11-836.e17. DOI: 10.1016/j.urolonc.2021.08.015. View

Mejean A, Ravaud A, Thezenas S, Colas S, Beauval J, Bensalah K . Sunitinib Alone or after Nephrectomy in Metastatic Renal-Cell Carcinoma. N Engl J Med. 2018; 379(5):417-427. DOI: 10.1056/NEJMoa1803675. View

Motzer R, Mcdermott D, Escudier B, Burotto M, Choueiri T, Hammers H . Conditional survival and long-term efficacy with nivolumab plus ipilimumab versus sunitinib in patients with advanced renal cell carcinoma. Cancer. 2022; 128(11):2085-2097. PMC: 9543316. DOI: 10.1002/cncr.34180. View

Aben K, Heskamp S, Janssen-Heijnen M, Koldewijn E, van Herpen C, Kiemeney L . Better survival in patients with metastasised kidney cancer after nephrectomy: a population-based study in the Netherlands. Eur J Cancer. 2011; 47(13):2023-32. DOI: 10.1016/j.ejca.2011.03.002. View

Rendon R . New surgical horizons: the role of cytoreductive nephrectomy for metastatic kidney cancer. Can Urol Assoc J. 2008; 1(2 Suppl):S62-8. PMC: 2422951. DOI: 10.5489/cuaj.69. View

Eggener S, Yossepowitch O, Kundu S, Motzer R, Russo P . Risk score and metastasectomy independently impact prognosis of patients with recurrent renal cell carcinoma. J Urol. 2008; 180(3):873-8. PMC: 2570431. DOI: 10.1016/j.juro.2008.05.006. View

Bex A, Mulders P, Jewett M, Wagstaff J, van Thienen J, Blank C . Comparison of Immediate vs Deferred Cytoreductive Nephrectomy in Patients With Synchronous Metastatic Renal Cell Carcinoma Receiving Sunitinib: The SURTIME Randomized Clinical Trial. JAMA Oncol. 2018; 5(2):164-170. PMC: 6439568. DOI: 10.1001/jamaoncol.2018.5543. View

Mekhail T, Abou-Jawde R, Boumerhi G, Malhi S, Wood L, Elson P . 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):832-41. DOI: 10.1200/JCO.2005.05.179. View

Kokorovic A, Rendon R . Cytoreductive nephrectomy in metastatic kidney cancer: what do we do now?. Curr Opin Support Palliat Care. 2019; 13(3):255-261. DOI: 10.1097/SPC.0000000000000433. View

10.

Bakouny Z, El Zarif T, Dudani S, Wells J, Gan C, Donskov F . Upfront Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma Treated with Immune Checkpoint Inhibitors or Targeted Therapy: An Observational Study from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol. 2022; 83(2):145-151. DOI: 10.1016/j.eururo.2022.10.004. View

11.

Motzer R, Bacik J, Murphy B, Russo P, Mazumdar M . Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol. 2002; 20(1):289-96. DOI: 10.1200/JCO.2002.20.1.289. View

12.

Matsubara N, Mukai H, Naito Y, Itoh K, Komai Y, Sakai Y . First experience of active surveillance before systemic target therapy in patients with metastatic renal cell carcinoma. Urology. 2013; 82(1):118-23. DOI: 10.1016/j.urology.2013.03.035. View

13.

Silagy A, Kotecha R, Weng S, Holmes A, Singla N, Mano R . Evolving biological associations of upfront cytoreductive nephrectomy in metastatic renal cell carcinoma. Cancer. 2021; 127(21):3946-3956. PMC: 8516697. DOI: 10.1002/cncr.33790. View

14.

McIntosh A, Umbreit E, Holland L, Gu C, Tannir N, Matin S . Optimizing patient selection for cytoreductive nephrectomy based on outcomes in the contemporary era of systemic therapy. Cancer. 2020; 126(17):3950-3960. DOI: 10.1002/cncr.32991. View

15.

Graham J, Dudani S, Heng D . Prognostication in Kidney Cancer: Recent Advances and Future Directions. J Clin Oncol. 2018; :JCO2018790147. DOI: 10.1200/JCO.2018.79.0147. View

16.

Wong A, Chong K, Heng C, Consigliere D, Esuvaranathan K, Toh K . Debulking nephrectomy followed by a "watch and wait" approach in metastatic renal cell carcinoma. Urol Oncol. 2008; 27(2):149-54. DOI: 10.1016/j.urolonc.2007.10.017. View

17.

Kushnir I, Basappa N, Ghosh S, Lalani A, Hansen A, Wood L . Active Surveillance in Metastatic Renal Cell Carcinoma: Results From the Canadian Kidney Cancer Information System. Clin Genitourin Cancer. 2021; 19(6):521-530. DOI: 10.1016/j.clgc.2021.05.004. View

18.

Rini B, Dorff T, Elson P, Suarez Rodriguez C, Shepard D, Wood L . Active surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. Lancet Oncol. 2016; 17(9):1317-24. PMC: 9199453. DOI: 10.1016/S1470-2045(16)30196-6. View

19.

Motzer R, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J . Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol. 1999; 17(8):2530-40. DOI: 10.1200/JCO.1999.17.8.2530. View

20.

Reig Torras O, Mishra A, Christie A, McKenzie T, Onabolu O, Singla N . Molecular Genetic Determinants of Shorter Time on Active Surveillance in a Prospective Phase 2 Clinical Trial in Metastatic Renal Cell Carcinoma. Eur Urol. 2022; 81(6):555-558. PMC: 9886196. DOI: 10.1016/j.eururo.2021.12.003. View