Oncology Trainee Northern Centre for cancer care Houghton Le Spring, England, United Kingdom
Background: Cytoreductive nephrectomy (CN) followed by systemic treatment had been the standard of care for mRCC patients during the cytokines era.Since the introduction of new and effective SACT,role of CN was less clear until the report of CARMENA trial.The aim of our study is to assess our practice and to evaluate the outcome of CN in patients with mRCC.
Methods: Retrospective analysis of patients treated at tertiary cancer centre in North England. We included 101 mRCC patients receiving SACT from Jan 2018 to July 2021
Results: N=32 patients had CN then commenced on SACT and N=69 patients had primary SACT alone. Median age was 65, ECOG-PS was 0-1 in 86% and 2 in 14%. IMDC risk groups were favourable in 31%, intermediate/poor in 53%/16%. Median OS was 64 vs 20 months in CN group and the SACT alone group respectively.Median OS in patients with PS 0-1 was 55.9 months in the CN group and was 20.6 in the SACT alone group.Median OS in patients with PS 2 or more was 15.2 in CN group and 9.9 months in SACT alone group.Median OS based on IMDC in CN group vs SACT group: 1) Favourable risk -133.4 vs 29.8 months 2) Intermediate risk-55.5 vs 28.6 months 3) Poor risk -15.2 vs 10.2 months Median OS in CN group was 48.9, 63.5 and 54.7 months in patients with one, two and three site of metastasis respectively.Median OS in SACT group was 24.4, 12.4, 19.3 and 16.5 months with one, two, three and four site of metastasis respectively.
Conclusions: Our real-world single centre analysis suggest that selected CN improve patient’s outcome regardless the number of metastasis however patients with poor PS and poor risk group did not seem to benefit. Median OS was clearly correlated to IMDC risk group and PS which is consistent with the published literature.