The benefit of cytoreductive nephrectomy (CNT) for cancer-specific mortality (CSM)-free survival is unclear in contemporary metastatic non-clear cell renal cell carcinoma (non-ccmRCC) patients.
To assess the role of CNT in non-ccmRCC patients.
Within Surveillance, Epidemiology, and End Results registry (2001-2014), we identified patients with non-ccmRCC.
CNT versus no CNT in non-ccmRCC patients.
Multivariable logistic regression, cumulative incidence, competing-risks regression models, incremental survival benefit (ISB), conditional survival, and landmark analyses were performed. Sensitivity analyses focused on histological subtypes and most contemporary patients (2010-2014).
Of 851 patients with non-ccmRCC, 67.6% underwent CNT. In multivariable logistic regression, year of diagnosis in contemporary (p<0.001) and intermediate (p=0.008) tertiles, as well as age ≥75 yr (p<0.001) yielded lower CNT rates. Cumulative incidence showed 2-yr CSM of 52.6% versus 77.7%, respectively, after CNT versus no CNT. CSM after CNT versus no CNT was invariably lower in all histologic subtypes and in contemporary patients. Multivariable competing-risks regression models predicting CSM favored CNT (hazard ratio [HR]: 0.38, confidence interval: 0.30-0.47, p<0.001) in all patients and in all subgroups defined by histologic subtypes (HR: 0.14-0.43, all p≤0.02), as well as in contemporary patients (HR: 0.32, p<0.001). The ISB analyses yielded statistically significant and clinically meaningful CSM-free survival benefit of +3 mo after CNT versus no CNT in individuals with observed CSM-free survival ≤24 mo. The 2-yr CSM-free survival increased from baseline of 46.1% versus 19.4% (Δ=26.7%, p<0.001) to 70.3% versus 54.4% (Δ=15.9%, p=0.005) after CNT versus no CNT, in patients that survived 12 mo, respectively. Landmark analyses rejected bias favoring CNT. Data were retrospective.
CSM is lower after CNT for non-ccmRCC in all histologic subtypes and in contemporary patients except for unproven ISB in collecting duct patients. This observation should encourage greater CNT consideration in non-ccmRCC.
Cytoreductive nephrectomy appears to improve survival in metastatic non-clear cell renal cell carcinoma, but it is used infrequently.
European urology focus. 2017 Dec 08 [Epub ahead of print]
Michele Marchioni, Marco Bandini, Felix Preisser, Zhe Tian, Anil Kapoor, Luca Cindolo, Giulia Primiceri, Francesco Berardinelli, Alberto Briganti, Shahrokh F Shariat, Luigi Schips, Pierre I Karakiewicz
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy. Electronic address: ., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada., Division of Urology, McMaster University, Hamilton, ON, Canada., Department of Urology, ASL Abruzzo 2, Chieti, Italy., Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy., Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy; Department of Urology, ASL Abruzzo 2, Chieti, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, University of Montreal Health Centre, Montreal, QC, Canada.