Immunotherapy-based systemic treatment (ST) is the standard of care for most patients diagnosed with metastatic renal cell carcinoma (mRCC). Cytoreductive nephrectomy (CN) has historically shown benefit for select patients with mRCC, but its role and timing are not well understood in the era of immunotherapy. The primary objective of this study is to assess outcomes in patients who received ST only, CN followed by ST (CN-ST), and ST followed by CN (ST-CN). The Canadian Kidney Cancer information system (CKCis) database was queried to identify patients with de novo mRCC who received immunotherapy-based ST between January 2014 and June 2023. These patients were classified into three categories as described above. Cox proportional hazards models were used to assess the impact of the timing of ST and CN on overall survival (OS) and progression-free survival (PFS), after adjusting for the International Metastatic RCC Database Consortium (IMDC) risk group, age, and comorbidities. Best overall response and complications of ST and CN for these cohorts were collected. A total of 588 patients were included in this study: 331 patients received ST only, 215 patients received CN-ST, and 42 patients received ST-CN. Patient and disease characteristics including age, gender, performance status, IMDC risk category, comorbidity, histology, type of ST, and metastatic sites are reported. OS analysis favored patients who received ST-CN (hazard ratio [HR] 0.30, 95% confidence interval [CI] 0.13-0.68) and CN-ST (HR 0.68, CI 0.47-0.97) over patients who received ST only. PFS analysis showed a similar trend for ST-CN (HR 0.45, CI 0.26-0.77) and CN-ST (HR 0.9, CI 0.68-1.17). This study examined baseline features and outcomes associated with the use and timing of CN and ST using real-world data via a large Canadian real-world cohort. Patients selected to receive CN after ST demonstrated improved outcomes. There were no appreciable differences in perioperative complications across groups. Limitations include the small number of patients in the ST-CN group and residual confounding and selection biases that may influence the outcomes in patients undergoing CN.
Current oncology (Toronto, Ont.). 2024 Aug 18*** epublish ***
Changsu Lawrence Park, Feras Ayman Moria, Sunita Ghosh, Lori Wood, Georg A Bjarnason, Bimal Bhindi, Daniel Yick Chin Heng, Vincent Castonguay, Frederic Pouliot, Christian K Kollmannsberger, Dominick Bosse, Naveen S Basappa, Antonio Finelli, Nazanin Fallah-Rad, Rodney H Breau, Aly-Khan A Lalani, Simon Tanguay, Jeffrey Graham, Ramy R Saleh
McGill University Health Centre, McGill University, Montreal, QC H4A 3J1, Canada., Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada., Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS B3H 3A7, Canada., Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada., Southern Alberta Institute of Urology, Calgary, AB T2V 1P9, Canada., Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada., Hotel Dieu de Quebec, Quebec, QC G1R 2J6, Canada., Department of Urology, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC G1V 0A6, Canada., British Columbia Cancer Agency, Vancouver, BC V5Z 3X7, Canada., Division of Oncology, University of Ottawa, Ottawa, ON K1N 6N5, Canada., Princess Margaret Cancer Centre UHN, Toronto, ON M4W 1H7, Canada., Juravinski Cancer Centre, McMaster University, Hamilton, ON L8S 4L8, Canada., Department of Oncology and Hematology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.