Cytoreductive Nephrectomy in Select Primary Metastatic Renal Cell Carcinoma Patients: A Comprehensive Nationwide Outcome Analysis

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2024 Mar 28

PMID 38539467

Authors

Nessn Azawi

Louise Geertsen

Naomi Nadler

Karina Sif Soendergaard Mosholt

Sofie Staal Axelsen

Jane Christensen

Niels Viggo Jensen

Niels Fristrup

Susanne Oksbjerg Dalton

Frede Donskov

Lars Lund

Affiliations

Soon will be listed here.

Abstract

(1) Background: The role of cytoreductive nephrectomy (CN) is controversial in patients with primary metastatic renal cell carcinoma (mRCC). (2) Methods: We evaluated the impact of CN, or no CN, followed by first-line targeted therapy (TT) in a nationwide unselected cohort of 437 consecutive patients with primary mRCC over a two-year period with a minimum of five years of follow-up. Data sources were national registries supplemented with manually extracted information from individual patient medical records. Cox proportional hazards estimated the hazard ratio (HR) of overall death and cancer-specific death after one and three years. (3) Results: 210 patients underwent CN and 227 did not. A total of 176 patients (40%) had CN followed by TT, 160 (37%) had TT alone, 34 (8%) underwent CN followed by observation, and 67 (15%) received no treatment. After adjustments in Model 2, patients treated with TT alone demonstrated a worsened overall survival (OS) compared to those treated with CN + TT, HR 0.63 (95% CI: 0.19-2.04). (4) Conclusions: In this nationwide study, CN was associated with enhanced outcomes in carefully selected patients with primary mRCC. Further randomized trials are warranted.

References

Iisager L, Ahrenfeldt J, Donskov F, Ljungberg B, Bex A, Lund L . Multicenter randomized trial of deferred cytoreductive nephrectomy in synchronous metastatic renal cell carcinoma receiving checkpoint inhibitors: the NORDIC-SUN-Trial. BMC Cancer. 2024; 24(1):260. PMC: 10893632. DOI: 10.1186/s12885-024-11987-3. View

Flanigan R, Mickisch G, Sylvester R, Tangen C, van Poppel H, Crawford E . Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol. 2004; 171(3):1071-6. DOI: 10.1097/01.ju.0000110610.61545.ae. View

Erichsen R, Lash T, Hamilton-Dutoit S, Bjerregaard B, Vyberg M, Pedersen L . Existing data sources for clinical epidemiology: the Danish National Pathology Registry and Data Bank. Clin Epidemiol. 2010; 2:51-6. PMC: 2943174. DOI: 10.2147/clep.s9908. 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

Donskov F, Xie W, Overby A, Wells J, Fraccon A, Sacco C . Synchronous Versus Metachronous Metastatic Disease: Impact of Time to Metastasis on Patient Outcome-Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol Oncol. 2020; 3(4):530-539. DOI: 10.1016/j.euo.2020.01.001. View

Kuusk T, Szabados B, Liu W, Powles T, Bex A . Cytoreductive nephrectomy in the current treatment algorithm. Ther Adv Med Oncol. 2019; 11:1758835919879026. PMC: 6767741. DOI: 10.1177/1758835919879026. View

Albiges L, Tannir N, Burotto M, McDermott D, Plimack E, Barthelemy P . First-line Nivolumab plus Ipilimumab Versus Sunitinib in Patients Without Nephrectomy and With an Evaluable Primary Renal Tumor in the CheckMate 214 Trial. Eur Urol. 2021; 81(3):266-271. PMC: 10202028. DOI: 10.1016/j.eururo.2021.10.001. View

Heravi G, Yazdanpanah O, Podgorski I, Matherly L, Liu W . Lipid metabolism reprogramming in renal cell carcinoma. Cancer Metastasis Rev. 2021; 41(1):17-31. PMC: 10045462. DOI: 10.1007/s10555-021-09996-w. View

Napolitano L, Manfredi C, Cirillo L, Fusco G, Passaro F, Abate M . Cytoreductive Nephrectomy and Metastatic Renal Cell Carcinoma: State of the Art and Future Perspectives. Medicina (Kaunas). 2023; 59(4). PMC: 10143323. DOI: 10.3390/medicina59040767. View

10.

Heng D, Wells J, Rini B, Beuselinck B, Lee J, Knox J . Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol. 2014; 66(4):704-10. DOI: 10.1016/j.eururo.2014.05.034. View

11.

Bamias A, Tzannis K, Papatsoris A, Oudard S, Beuselinck B, Escudier B . Prognostic significance of cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma treated with first-line sunitinib: a European multiinstitutional study. Clin Genitourin Cancer. 2014; 12(5):373-83. DOI: 10.1016/j.clgc.2014.03.012. View

12.

Marchioni M, Bandini M, Preisser F, Tian Z, Kapoor A, Cindolo L . Survival after Cytoreductive Nephrectomy in Metastatic Non-clear Cell Renal Cell Carcinoma Patients: A Population-based Study. Eur Urol Focus. 2017; 5(3):488-496. DOI: 10.1016/j.euf.2017.11.012. View

13.

Gjerstorff M . The Danish Cancer Registry. Scand J Public Health. 2011; 39(7 Suppl):42-5. DOI: 10.1177/1403494810393562. View

14.

Petersen A, Sogaard M, Mehnert F, Larsen E, Donskov F, Azawi N . The database of the Danish Renal Cancer Group. Clin Epidemiol. 2016; 8:725-729. PMC: 5098506. DOI: 10.2147/CLEP.S106042. View

15.

Ljungberg B, Sundqvist P, Lindblad P, Kjellman A, Thorstenson A, Hellstrom M . Survival advantage of upfront cytoreductive nephrectomy in patients with primary metastatic renal cell carcinoma compared with systemic and palliative treatments in a real-world setting. Scand J Urol. 2020; 54(6):487-492. DOI: 10.1080/21681805.2020.1815833. View

16.

Choueiri T, Xie W, Kollmannsberger C, North S, Knox J, Lampard J . The impact of cytoreductive nephrectomy on survival of patients with metastatic renal cell carcinoma receiving vascular endothelial growth factor targeted therapy. J Urol. 2010; 185(1):60-6. DOI: 10.1016/j.juro.2010.09.012. View

17.

Graham J, Wells J, Donskov F, Lee J, Fraccon A, Pasini F . Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol Oncol. 2019; 2(6):643-648. PMC: 6886238. DOI: 10.1016/j.euo.2019.03.007. View

18.

Hanna N, Sun M, Meyer C, Nguyen P, Pal S, Chang S . Survival Analyses of Patients With Metastatic Renal Cancer Treated With Targeted Therapy With or Without Cytoreductive Nephrectomy: A National Cancer Data Base Study. J Clin Oncol. 2016; 34(27):3267-75. PMC: 5024547. DOI: 10.1200/JCO.2016.66.7931. View

19.

Schmidt M, Schmidt S, Sandegaard J, Ehrenstein V, Pedersen L, Sorensen H . The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol. 2015; 7:449-90. PMC: 4655913. DOI: 10.2147/CLEP.S91125. View

20.

Schmidt M, Pedersen L, Sorensen H . The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol. 2014; 29(8):541-9. DOI: 10.1007/s10654-014-9930-3. View