Presentation Authors: Florian Janisch, Constantin Fühner, Christian P. Meyer, Tobias Hillemacher, Thomas Klotzbücher, Christina Kienapfel, Malte Vetterlein, Roland Dahlem, Hamburg, Germany, Shahrokh F. Shariat, Vienna, Austria, Margit Fisch, Michael Rink*, Hamburg, Germany
Introduction: While cytoreductive nephrectomy (CN) was standard of care for a decade, the results of the CARMENA trial have challenged the role of CN in the multi-kinase receptor inhibitor (TKI) era. However, CARMENA focused on patients with MSKCC intermediate and poor prognosis scores. We sought to investigate the role of CN in a real-world metastatic renal cell carcinoma (mRCC) population.
Methods: We collected data of 398 patients with mRCC at our academic center. Patients with previous immunotherapy, metastasectomy only treatment and missing data were excluded. A final cohort of 262 pts. remained for analyses. Patients received either CN and subsequent TKI or immediate TKI treatement. Differences in patient characteristics and outcomes were analyzed using descriptive analytics, Kaplan-Meier estimations and uni- and multivariable Cox regression proportional with regards to CN administration.
Results: The median age of our cohort was 62 yrs., 193 (74%) pts. were male and 214 (82%) had clear-cell RCC (ccRCC) histology. In total, 105 pts. (40.1%) received CN and 157 (59.9%) were treated with TKI therapy immediately. There was no difference in type of TKIs or lines of treatment between both groups. The majority of patients received sunitinib (66%) or sorafenib (20%) as first line treatment. According to the MSKCC risk score, 22.5%, 58.4% and 19.1% patients fell into the good, intermediate and poor prognosis group, respectively. Patients treated with CN were statistically significant younger and had more advanced tumor stages, higher MSKCC risk scores and more frequently sarcomatoid tumor features (all pï‚£0.004). At a median follow-up of 33 months, in overall unadjusted Kaplan-Meier analyses pts. with CN had significantly worse overall, cancer-specific (both p=0.004) and progression-free survival (PFS; p=0.003), respectively. In multivariable analyses, that adjusted for standard clinic-pathologic factors CN was not an independent predictor for inferior outcomes. In contrast, higher ECOG score, non-ccRCC, sarcomatoid tumor features, and less favorable MSKCC risk score were independent predictors for inferior survival for all three endpoints (p-valuesï‚£0.022). In addition, higher T-stage was associated with worse overall survival (p=0.014) and the number of TKI lines was associated with PFS (p=0.001).
Conclusions: There is no difference in overall, cancer-specific and progression-free survival with or without CN in our real-world series including pts. with good MSKCC risk scores. Our results warrant confirmation in the new era including checkpoint inhibitor immunotherapy.