Partial nephrectomy predicts survival among metastatic RCC patients

By Sarah Pritchard, medwireNews Reporter

Cytoreductive nephrectomy (CN) predicts improved survival among patients with metastatic renal cell carcinoma (RCC) and synchronous metastases who have received first-line treatment with sunitinib, indicate study findings.

Not only did patients who underwent CN have an approximate 50% reduction in the risk of death compared with their counterparts who did not undergo the procedure, CN remained significantly independently predictive of prolonged survival in multivariate analysis.

However, Aristotle Bamias (University of Athens, Greece) and colleagues warn that the exact role of CN and the best method for selecting subgroups of patients most likely to gain a survival benefit still need to be clarified by the results of ongoing randomised clinical trials.

In the meantime, “real-world evidence will still be helpful in making therapeutic decisions”, they write in Clinical Genitourinary Cancer.

Reviewing data for 186 metastatic RCC patients aged a median of 58 years who had all received the vascular endothelial growth factor (VEGF) tyrosine kinase inhibitor sunitinib, the team found that the 150 (81%) patients who had also undergone CN were younger, had a better Eastern Cooperative Oncology Group performance status (PS) and survived for significantly longer than their peers who did not undergo CN.

At a median follow up of 34 months, overall survival was 21 months for the whole cohort, 24 months for those who had undergone CN and 9 months for those who had not.

Being aged under 65 years, having a PS of at least 1 versus 0 and having clear cell carcinoma versus another type of histology were all also significant predictive factors for survival. And, when CN was added to this multivariate analysis, it retained its significant prognostic ability, with a hazard ratio of 0.54.

Bamias and co-workers performed an exploratory stratified analysis to attempt to identify specific subgroups who may benefit from CN. However, no significant interactions were found between CN and the variables from the multivariate analysis, between CN and the number of metastatic sites, or between CN and scores for two widely used models (Memorial Sloan Kettering Cancer Center risk stratification and International Metastatic Renal Cell Carcinoma Database Consortium model).

Indeed, “nephrectomy retained its independent prognostic significance in all cases”, they report.

The team believes the results indicate that nephrectomy remains a valid current option for patients with synchronous metastases from RCC who have received any VEGF-targeted therapy, not just sunitinib.

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