16: Clinical Outcome of Patients with Primary Metastatic Renal Cell Carcinoma Carefully Selected for Cytoreductive Nephrectomy: A Nationwide Real-World Data
Associate professor Zealand University Hospital Roskilde, Denmark
Background: The role of cytoreductive nephrectomy (CN) is controversial in patients with primary metastatic renal cell carcinoma (mRCC). The aim in the present study was to determine the clinical outcomes in patients receiving CN compared to outcomes in non-CN patients.
Methods: We evaluated the impact of CN, or no CN, followed by first-line targeted therapy in a nationwide unselected cohort of 437 consecutive patients over a two-year period and with a minimum of five years of follow-up. Data sources were national registries supplemented with information extracted manually from the individual patient medical records. Outcome Measures: Cox proportional hazards were used to estimate the hazard ratio (HR) of overall death and cancer-specific death after one year and three years. The adjustment was performed stepwise. Model 1 adjusted for age, gender, Leibovich score, sarcomatoid differentiation. Model 2 included model 1 + adjusted for smoking, hypertension, performance status, and decision taken by MDT.
Results: Overall, 210 had CN and 227 had no CN. Patients who received cytoreductive nephrectomy followed by oncological treatment had 1-year mortality HR of 0.74; (0.39-1.41) in model 1, and 0.66; (0.34-1.28) in model 2 compared to cytoreductive nephrectomy alone, oncological treatment alone, and no-treatment. The 3-year mortality was only affected by the IMDC classification, where patients in the intermediate/favorable risk group compared to the poor risk group had improved survival; HR 0.56; (0.42-0.76) in model 1, HR 0.56; (0.41-0.77) in model 2.
Conclusions: In this nationwide study of patients with primary mRCC, CN was associated with improved outcomes for carefully selected patients. Further randomized trials are warranted. Patients’ summary: Overall, the study demonstrated that CN patients had improved clinical outcomes compared to those not receiving treatment.