Associate professor Zealand University Hospital Roskilde, Denmark
Background: Tumor recurrence post-nephrectomy in RCC patients is common, carries an unfavorable prognosis, and varies with risk category. The objective of this study was to describe demographic and clinical characteristics of post-surgery RCC patients with localized or locally advanced disease in a national Danish cohort, as well as a subpopulation who fit the risk categories from the adjuvant KEYNOTE-564 trial.
Methods: This retrospective analysis included individuals with a RCC diagnosis between [2014- 2017] in the Danish Renal Cancer (DaRenCa) Database, who subsequently underwent radical or partial nephrectomy. Outcomes were demographic and clinical characteristics, rates and sites of recurrence, and factors associated with recurrence. Recurrence rates were also assessed in a subpopulation stratified using the risk classifications of the KEYNOTE-564 trial. Data was confirmed from medical records.
Results: A total of 2,164 RCC patients were identified. The median age was 66.6, and 65.6% were male. Most patients (n=1,835, 84.8%) were M0, ECOG PS=0 (69.4%), pT1 at diagnosis (71.7%), Nx (lymphadenectomy not performed [78.8%]), clear cell histology (74.4%), and a Fuhrman grade of 2 (50.4%). 250 of the M0 patients (13.6%) recurred in the study period and was associated with male sex, higher T stage, radical nephrectomy, and higher Leibovich score. 74,9% of M0 patients recurred at distant metastatic sites; most common sites were lung (43.6%) and bone (18.8%). A total of 394 patients were stratified by the KEYNOTE-564 risk classification: 335 intermediate-high risk (85.0%), 17 high risk (4.3%), and 42 M1 NED (10.7%). Recurrence rates were 37.0%, 76.5%, and 28.6%, respectively, in these risk groups. Censoring at death likely reduced estimated recurrence rate for M1 NED.
Conclusions: This study provides a comprehensive picture of clinical characteristics for recurring RCC patients in Denmark and for a subgroup of patients suited for KEYNOTE-564.