The effectiveness of the clinical outcome of CN (Cytoreductive Nephrectomy) in cases of mccRCC (Metastatic Clear Cell Renal cell Carcinoma) is still uncertain despite two trials, SURTIME and CARMENA. These trials, conducted with Sunitinib as the standard treatment, did not provide evidence supporting the use of CN.
We queried the NCDB for stage IV mccRCC patients between the years of 2004 to 2020, who received (immunotherapy) IO with or without nephrectomy. Overall survival (OS) was calculated among three groups of IO alone, IO followed by CN (IOCN), CN followed by IO (CNIO). Cox models compared OS by treatment group after adjusting for sociodemographic, health, and facility variables.
From 1,549,101 renal cancer cases, 7983 clear and nonclear cell renal cell carcinoma cases were identified. After adjusting for sociodemographic and health covariates, patients who received IO followed by CN or CN followed by IO had a respective 64% (adjusted Hazard Ratio [aHR] = 0.36, 95% CI = 0.30-0.43, P = .006] and 47% (aHR = 0.53, 95% CI = 0.49-0.56, P = .001) mortality risk reduction respectively compared to patients who received IO alone. Compared to White adults, individuals who identified as Black exhibited 17% higher risk mortality (aHR = 1.17, 95% CI = 1.06-1.30, P = .002). Patients who received CN prior to IO had a 59% associated mortality risk compared to patients who received IO followed by CN who had a lower risk, 35.7% (P < .001).
Patients receiving CN regardless of sequence with IO did better than IO alone in this national registry-based adjusted analysis for mccRCC. Presently available data indicates that the combination of CN and IO holds promise for enhancing clinical results in patients with mRCC.
Clinical genitourinary cancer. 2024 Aug 21 [Epub ahead of print]
Maroun Bou Zerdan, Stephanie Niforatos, Swathi Arunachalam, Tamara Jamaspishvili, Roger Wong, Gennady Bratslavsky, Joseph Jacob, Jeffrey Ross, Oleg Shapiro, Hanan Goldberg, Alina Basnet
Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY., Department of Pathology and Molecular Medicine, SUNY Upstate Medical University, Syracuse, NY., Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY; Department of Geriatrics, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY., Department of Urology, SUNY Upstate Medical University, Syracuse, NY., Department of Pathology and Molecular Medicine, SUNY Upstate Medical University, Syracuse, NY; Department of Urology, SUNY Upstate Medical University, Syracuse, NY; Foundation Medicine, Inc., Morrisville, NC., Department of Hematology and Oncology, SUNY Upstate Medical University, Syracuse, NY. Electronic address: .