To quantify the magnitude of benefit of metastasectomy as compared to medical treatment alone in patients with metastatic renal cell carcinoma (mRCC).
We therefore conducted a propensity score analysis of overall survival (OS) in 106 mRCC patients with metachronous metastasis, of whom 36 (34%) were treated with metastasectomy, and 70 (66%) with medical therapy alone.
The most frequent metastasectomy procedures were lung resections (n = 13) and craniotomies (n = 6). Median time-to-progression after metastasectomy was 0.7 years (25th-75th percentile: 0.3-2.7). After a median follow-up of 6.2 years and 63 deaths, 5-year OS estimates were 41% and 22% in the metastasectomy and medical therapy group, respectively (log-rank P = .00007; Hazard ratio (HR) = 0.38, 95%CI: 0.21-0.68). Patients undergoing metastasectomy had a significantly higher prevalence of favorable prognostic factors, such as fewer bilateral lung metastases and longer disease-free intervals between nephrectomy and metastasis diagnosis. After propensity score weighting for these differences and adjusting for immortal time bias, the favorable association between metastasectomy and OS became much weaker (HR = 0.62, 95%CI: 0.39-1.00, P = .050). Propensity-score-weighted 5-year OS estimates were 24% and 20% in the metastasectomy and medical therapy group, respectively (log-rank P = .001). In exploratory analyses, the benefit of metastasectomy was confined to patients who achieved complete resection of all known metastases.
Within the limitations of an observational study, these findings support the concept of metastasectomy being associated with an OS benefit in mRCC patients. Metastasectomies not achieving complete resection of all known lesions are likely without OS benefit.
Clinical genitourinary cancer. 2022 Mar 24 [Epub ahead of print]
Franziska Maisel, Maria A Smolle, Stefanie Mollnar, Jakob M Riedl, Dominik A Barth, Maximilian Seles, Angelika Terbuch, Christopher H Rossmann, Florian Eisner, Sebastian Mannweiler, Georg Hutterer, Richard Zigeuner, Karl Pummer, Freyja-Maria Smolle-Jüttner, Jörg Lindenmann, Michael Stotz, Armin Gerger, Philipp J Jost, Thomas Bauernhofer, Martin Pichler, Florian Posch
Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria., Department of Orthopedics & Trauma, Medical University of Graz, Graz, Austria; Center for Biomarker Research in Medicine Ges.m.b.H. (CBmed), Graz, Austria., Department of Urology, Medical University of Graz, Graz, Austria., Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria., Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Graz, Austria., Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Center for Biomarker Research in Medicine Ges.m.b.H. (CBmed), Graz, Austria., Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Medicine III, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany., Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer, Houston, TX., Division of Haematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. Electronic address: .