Cytoreductive nephrectomy benefits limited by preoperative risk factors

By Laura Cowen, medwireNews Reporter

The survival benefit of cytoreductive nephrectomy (CN) when used in conjunction with targeted therapy for metastatic renal cell carcinoma (mRCC) depends on the number of preoperative risk factors a patient carries, study findings indicate.

Choung-Soo Kim (Asan Medical Center, Seoul, South Korea) and colleagues identified four risk factors that could be used to select mRCC patients who would not benefit from CN. Patients with two or more of these risk factors who received CN did not live any longer than patients receiving targeted therapy alone, the team reports in the Japanese Journal of Clinical Oncology.

The findings are based on a review of the medical records of 96 patients with mRCC who underwent CN followed by targeted therapy, and 75 patients who were treated with targeted therapy alone. None of the patients had received systemic therapy before enrolment.

Overall, patients in the CN group survived significantly longer than those in the non-CN group, at a median of 19.9 versus 11.7 months.

However, Cox proportional hazards modelling showed that a preoperative Karnofsky performance status below 80, a haemoglobin level less than the lower limit of normal, neutrophils greater than the upper limit of normal and clinical N2 stage were all independently associated with increased postoperative mortality, at respective hazard ratios of 9.50, 1.91, 6.53 and 2.71.

Furthermore, the number of preoperative risk factors was associated with overall survival. Specifically, patients in the CN group who had two or more risk factors had worse overall survival than the patients who did not undergo CN, at 8.3 versus 11.7 months.

When the researchers stratified both groups by the number of risk factors present at baseline, they observed similar results. Only those patients with fewer than two risk factors significantly benefitted from CN, with overall survival times of 29.9 versus 18.1 months in the CN and non-CN groups, respectively.

Patients with two or more risk factors did not benefit from upfront CN when compared with patients who had the same risk stratification but were treated with targeted therapy alone, at a median overall survival of 8.6 versus 8.2 months.

Kim et al suggest that the unfavourable results in patients with two or more risk factors might “be attributable to the rapid disease progression observed in some patients after CN.”

They conclude: “Patients with two or more pre-operative risk factors should be directed toward targeted therapy alone, thus helping them to avoid the morbidity associated with CN.”

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