To date, multidisciplinary team (MDT) evaluation, enrollment in trials evaluating the role of perioperative therapies and deferred active treatments represent accepted strategies for patients with Renal Cell Carcinoma (RCC), which are under investigation to maximize cancer control and implement health care policies and value-based care. Here, we aimed to identify subgroups of patients with RCC who may benefit from early referral for MDT evaluation at diagnosis in light of an increased risk of recurrence relative to the risk of dying of other causes.
We relied on a prospective dataset including patients diagnosed with RCC from 1998 to 2019 and treated by means of surgery alone at a tertiary referral center. The risk of other cause mortality (OCM) was evaluated against the risk of distant metastasis over time by means of the Weibull regression. Patients were stratified based on clinical stage (cT1a; cT1b; cT2; cT3-4), age (<60; 60-70; >70) and comorbidities [Charlson comorbidity index (CCI) 0 vs. ≥1]. For each combination of cT stage, age, and CCI, the potential need for an MDT referral was defined when the risk of recurrence exceeded the risk of OCM within the lower limit of the 95% CI of the meantime to recurrence.
Overall, 1,162 (51%) patients had no comorbidities. Median follow-up was 7 years. Patients who would benefit most from an MDT evaluation are those diagnosed with A) cT3-4 disease (any age or comorbidity) or B) cT2 cancers if healthy and younger than 70 years or younger than 60 years with at least 1 comorbidity or C) cT1b if younger than 60 years and without comorbidities.
Our findings can help selecting the optimal candidates for multidisciplinary evaluations and to consider RCC patients for clinical trials, deferred treatment, and treatment policy improvement. Also, our findings can be useful in the case of major healthcare disruptions, such as pandemics.
Urologic oncology. 2022 Jun 03 [Epub ahead of print]
Alberto Martini, Giuseppe Fallara, Antony A Pellegrino, Luigi Nocera, Alessandro Larcher, Daniele Raggi, Riccardo Campi, Guillaume Ploussard, Bernard Malavaud, Francesco Montorsi, Sumanta K Pal, Philippe E Spiess, Toni K Choueiri, Andrea Necchi, Umberto Capitanio
Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Institut Universitaire du Cancer Toulouse - Oncopôle, Toulouse, France; Department of Urology, La Croix du Sud Hôpital, Toulouse, France. Electronic address: ., Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy., Department of Medical Oncology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy., Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Department of Urology, Institut Universitaire du Cancer Toulouse - Oncopôle, Toulouse, France; Department of Urology, La Croix du Sud Hôpital, Toulouse, France., Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA., Moffitt Cancer Center and Research Institute, Tampa, FL., Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Institut Universitaire du Cancer Toulouse - Oncopôle, Toulouse, France. Electronic address: .