Survival after Cytoreductive Nephrectomy in Metastatic Non-clear Cell Renal Cell Carcinoma Patients: A Population-based Study.

Abstract

BACKGROUND:

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.

OBJECTIVE:

To assess the role of CNT in non-ccmRCC patients.

DESIGN, SETTING, AND PARTICIPANTS:

Within Surveillance, Epidemiology, and End Results registry (2001-2014), we identified patients with non-ccmRCC.

INTERVENTION:

CNT versus no CNT in non-ccmRCC patients.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

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).

RESULTS AND LIMITATIONS:

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.

CONCLUSIONS:

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.

PATIENT SUMMARY:

Cytoreductive nephrectomy appears to improve survival in metastatic non-clear cell renal cell carcinoma, but it is used infrequently.

• Authors: 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
• Journal: European urology focus (Eur Urol Focus) Vol. 5 Issue 3 Pg. 488-496 (May 2019) ISSN: 2405-4569 [Electronic] Netherlands
• PMID: 29229582 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Carcinoma, Renal Cell (mortality, pathology, surgery)
• Cytoreduction Surgical Procedures (methods, mortality)
• Female
• Humans
• Kidney Neoplasms (mortality, pathology, surgery)
• Logistic Models
• Male
• Middle Aged
• Nephrectomy (methods, mortality)
• Retrospective Studies
• Risk Factors
• SEER Program
• Socioeconomic Factors
• Survival Analysis
• Young Adult