Complete metastasectomy in renal cell carcinoma: a propensity-score matched by the International Metastatic RCC Database Consortium prognostic model.

Aline F Fares,Augusto Obuti Saito,Aldo A Dettino,Isabela W Cunha,Vinicius Calsavara,Walter H Da Costa,Stenio Zequi,Maria Nirvana Formiga,Daniel V Araujo

doi:10.3332/ecancer.2019.967

Aline F Fares, Augusto Obuti Saito + Show 7 more

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https://doi.org/10.3332/ecancer.2019.967

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Abstract

IntroductionWe evaluated overall survival (OS) benefit of complete metastasectomy (CM) in metastatic renal cell carcinoma (mRCC) using a propensity score-matched (PSM) analysis to balance groups by age, gender and by the International Metastatic RCC Database Consortium prognostic model (IMDC).MethodsWe included patients (pts) treated at the AC Camargo Cancer Center between 2007 and 2016. Pairs were matched by age, gender and IMDC. Kaplan–Meier survival estimates and Cox proportional hazard models were used to evaluate OS on CM and no-CM group.ResultsWe found 116 pts with clear cell mRCC. After PSM, the number was reduced to 74 (37 CM, 37 no-CM). The median OS for CM and no-CM was 98.3 months and 40.5 months, respectively (hazard ratio 0.24 95%CI 0.11–0.53 p < 0.001). The OS benefit of CM was confirmed on favourable and intermediate IMDC but was absent on poor IMDC. The CM group received less systemic therapy than the no-CM group. Ten pts in the CM group still have no evidence of disease (NED).ConclusionAfter matching for age, gender and IMDC, we found CM impacts on OS and also diminishes the need for systemic treatment. Survival benefit was confirmed for favourable/intermediate IMDC but not for the poor IMDC prognostic model. Further studies correlating IMDC and metastasectomy are needed to guide clinical decision-making.

Highlights

We evaluated overall survival (OS) benefit of complete metastasectomy (CM) in metastatic renal cell carcinoma using a propensity score-matched (PSM) analysis to balance groups by age, gender and by the International Metastatic RCC Database Consortium prognostic model (IMDC)
We investigate the role of metastasectomy in a PSM population accounting for known prognostic factors in metastatic renal cell carcinoma (mRCC) such as age, gender and IMDC criteria
After matching pairs for age, gender and IMDC criteria, groups were reduced to 74 patients: 37 on the CM group and 37 on the no-CM group as depicted in the flowchart (Figure 1)

Summary

Introduction

We evaluated overall survival (OS) benefit of complete metastasectomy (CM) in metastatic renal cell carcinoma (mRCC) using a propensity score-matched (PSM) analysis to balance groups by age, gender and by the International Metastatic RCC Database Consortium prognostic model (IMDC). The treatment of metastatic renal cell carcinoma (mRCC) has changed dramatically over the last 30 years. Surgery or stereotactic radiosurgery of metastatic sites can be offered aiming to prolong time-to-treatment and OS [2, 3]. These treatments are offered to a selected population with good performance status and fit enough to undergo surgical interventions with an underlying active cancer. Mostly retrospective, found improvements in survival, showing 5-year survival rates of up to 80% in patients undergoing metastasectomy, with variations depending on site of metastasectomy [4,5,6,7,8,9]. Lung and pancreatic metastasectomies appear to have higher rates of success and better survival, whereas bone and liver are related to worse survival [10, 11]

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