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Impact of Metastasectomy on Cancer Specific and Overall Survival in Metastatic Renal Cell Carcinoma: Analysis of the REMARCC Registry

Published:April 08, 2022DOI:https://doi.org/10.1016/j.clgc.2022.03.013

      Abstract

      Background

      Treatment paradigms for management of metastatic renal cell carcinoma (mRCC) are evolving. We examined impact of surgical metastasectomy on survival across in mRCC stratified by risk-group.

      Methods

      Multicenter retrospective analysis from the Registry of Metastatic RCC database. The cohort was subdivided utilizing Motzer criteria (favorable-, intermediate-, high-risk). Primary outcome was all-cause mortality (ACM)/overall survival (OS); secondary outcome was cancer-specific mortality (CSM)/cancer-specific survival (CSS). Impact of metastasectomy was analyzed via Cox-Regression analysis adjusting for potential prognostic variables and Kaplan-Meier analysis (KMA) within each risk-group.

      Results

      Four hundred thirty-one patients (59 favorable-risk, 274 intermediate-risk, 98 high-risk; median follow-up 27.2 months) were analyzed. Metastasectomy was performed in 22 (37%), 66 (24%), and 32 (16%) of favorable-, intermediate- and high-risk groups (P = .012). Median number of metastases at diagnosis differed significantly (favorable-risk 2, intermediate-risk 3.4, high-risk 5.1, P < .001). On Cox-regression, high-risk (HR = 1.72, P = .002) was associated with worsened ACM, while metastasectomy was associated with improved ACM (HR = 0.56, P = .005). On KMA, median OS (months) was longer with metastasectomy in favorable- (92.7 vs. 25.8, P = .003) and intermediate-risk (26.3 vs. 20.1, P = .038), but not high-risk (P = .911) groups. Metastasectomy was associated with longer CSS in favorable- (76.1 vs. 32.8, P = .004) but not intermediate- (P = .06) and high-risk (P = .595) groups.

      Conclusions

      Metastasectomy was independently associated with improved ACM and CSM, as well as improved CSS and OS in favorable- and intermediate-risk mRCC patients. Metastasectomy may be considered as component of multimodal management strategy in favorable and intermediate-risk subgroups. In high-risk patients, metastasectomy should be deferred except in select circumstances.

      Keywords

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      References

        • Znaor A
        • Lortet-Tieulent J
        • Laversane M
        • Jemal A
        • Bray F
        International variations and trends in renal cell carcinoma incidence and mortality.
        Eur Urol. 2015; 67: 519-530
        • Siegel RL
        • Miller KD
        • Jemal A
        Cancer statistics, 2020.
        CA Cancer J Clin. 2020; 70: 7-30
        • Capitanio U
        • Montorsi F
        Renal cancer.
        Lancet. 2016; 387: 894-906
        • Ryan ST
        • Patel DN
        • Ghali F
        • et al.
        Impact of positive surgical margins on survival after partial nephrectomy in localized kidney cancer: analysis of the National Cancer Database.
        Minerva Urol Nefrol. 2020; ([Epub ahead of print])https://doi.org/10.23736/S0393-2249.20.03728-5
        • Field CA
        • Cotta BH
        • Jimenez J
        • et al.
        Neoadjuvant sunitinib decreases inferior vena caval thrombus size and is associated with improved oncologic outcomes: a multicenter comparative analysis.
        Clin Genitourin Cancer. 2019; 17: e505-e512
        • Patel SH
        • Uzzo RG
        • Larcher A
        • et al.
        Oncologic and functional outcomes of radical and partial nephrectomy in pT3a pathologically upstaged renal cell carcinoma: a multi-institutional analysis.
        Clin Genitourin Cancer. 2020; (S1558-7673(20)30100-2Online ahead of print)https://doi.org/10.1016/j.clgc.2020.05.002
        • Omid S
        • Abufaraj M
        • Remzi M
        Metastasectomy in patients with renal cell carcinoma: when and how?.
        Curr Opin Urol. 2020; 30: 602-609
        • Motzer RJ
        • Jonasch E
        • Michaelson MD
        • et al.
        NCCN guidelines insights: kidney cancer, version 2.2020.
        J Natl Compr Canc Netw. 2019; 17: 1278-1285
        • Ljungberg B
        • Albiges L
        • Abu-Ghanem Y
        • et al.
        European Association of Urology Guidelines on Renal Cell Carcinoma: the 2019 update.
        Eur Urol. 2019; 75: 799-810
        • Mani S
        • Todd MB
        • Katz K
        • Poo WJ
        Prognostic factors for survival in patients with metastatic renal cancer treated with biological response modifiers.
        J Urol. 1995; 154: 35-40
        • Hamilton Z
        • Lee HJ
        • Jimenez J
        • et al.
        Change in platelet count as a prognostic indicator for response to primary tyrosine kinase inhibitor therapy in metastatic renal cell carcinoma.
        BJU Int. 2016; 118: 927-934
        • Panian J
        • Lin X
        • Simantov R
        • et al.
        the impact of age and gender on outcomes of patients with advanced renal cell carcinoma treated with targeted therapy.
        Clin Genitourin Cancer. 2020; 18: e598-e609
        • Zhang N
        • Zhang H
        • Zhu D
        • et al.
        Prognostic role of pretreatment lactate dehydrogenase in patients with metastatic renal cell carcinoma: a systematic review and meta-analysis.
        Int J Surg. 2020; 79: 66-73
        • Motzer FJ
        • Bacik J
        • Schwartz LH
        • et al.
        Prognostic factors for survival in previously treated patients with metastatic renal cell carcinoma.
        J Clin Oncol. 2004; 2: 454-463
        • Heng D
        • Xie W
        • Regan M
        • et al.
        External validation and comparison with other models of the international metastatic renal-cell carcinoma database consortium prognostic model: a population-based study.
        Lancet Oncol. 2013; 4: 141-148
        • Flanigan RC
        • Yonover PM
        The role of resection for patients with renal carcinoma.
        Curr Oncol Rep. 2001; 3: 424-432
        • Roussel E
        • Campi R
        • Larcher A
        • et al.
        Rates and predictors of perioperative complications in cytoreductive nephrectomy: analysis of the registry for metastatic renal cell carcinoma.
        Eur Urol Oncol. 2020; 3: 523-529
        • Schwartz LH
        • Mazumdar M
        • Wang L
        • et al.
        Response assessment classification in patients with advanced renal cell carcinoma treated on clinical trials.
        Cancer. 2003; 98: 1611-1619
        • Therasse P
        • Arbuck SG
        • Eisenhauer EA
        • et al.
        New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada.
        J Natl Cancer Inst. 2000; 92: 205-216
        • Kim SH
        • Park WS
        • Kim SH
        • et al.
        Systemic treatments for metastatic renal cell carcinoma: 10-year experience of immunotherapy and targeted therapy.
        Cancer Res Treat. 2016; 48: 1092-1101
        • Mekhail TM
        • Abou-Jawde RM
        • Boumehri G
        • et al.
        Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma.
        J Clin Oncol. 2005; 23: 832-841
        • Dindo D
        • Demartines N
        • Clavien PA
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Ljungberg B
        The role of metastasectomy in renal cell carcinoma in the era of targeted therapy.
        Curr Urol Rep. 2013; 14: 19-25
        • Kierney PC
        • van Heerden JA
        • Segura JW
        • Weaver AL
        Surgeon's role in the management of solitary renal cell carcinoma metastases occurring subsequent to initial curative nephrectomy: an institutional review.
        Ann Surg Oncol. 1994; 1: 345-352
        • Kavolius JP
        • Mastorakos DP
        • Pavlovich C
        • Russo P
        • Burt ME
        • Brady MS
        Resection of metastatic renal cell carcinoma.
        J Clin Oncol. 1998; 16: 2261-2666
        • Eggener SE
        • Yossepowitch O
        • Kundu S
        • Motzer RJ
        • Russo P
        Risk score and metastasectomy independently impact prognosis of patients with recurrent renal cell carcinoma.
        J Urol. 2008; 180: 873-878
        • Palumbo C
        • Pecoraro A
        • Knipper S
        • et al.
        Survival and complication rates of Metastasectomy in patients with metastatic renal cell carcinoma treated exclusively with targeted therapy: a combined population-based analysis.
        Anticancer Res. 2019; 38: 4357-4361
        • Ouzaid I
        • Capitanio U
        • Staehler M
        • et al.
        Surgical metastasectomy in renal cell carcinoma: a systematic review.
        Eur Urol Oncol. 2019; 2: 141-149
        • Motzer RJ
        • Mazumdar M
        • Bacik J
        • et al.
        Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma.
        J Clin Oncol. 1999; 17: 2530-2540
        • Motzer RJ
        • Bacik J
        • Murphy BA
        • et al.
        Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma.
        J Clin Oncol. 2002; 20: 289-296
        • Karakiewicz PI
        • Sun M
        • Bellmunt J
        • Sneller V
        • Escudier B
        Prediction of progression-free survival rates after bevacizumab plus interferon versus interferon alone in patients with metastatic renal cell carcinoma: comparison of a nomogram to the Motzer criteria.
        Eur Urol. 2011; 60: 48-56