Abstract
BackgroundTo assess the prognostic and predictive factors of time to treatment failure (TTF) and overall survival (OS), respectively, in patients with metachronous metastatic renal cell carcinoma (mRCC) who were treated with targeted agents.Materials and MethodsWe retrospectively reviewed metachronous mRCC patients, defined as individuals diagnosed with metastatic disease >3 months after initial nephrectomy, treated at an institute since 2005. Cox proportional hazard regression analysis was performed to discover the most determinant variables associated with TTF and OS.ResultsSarcomatoid features, absence of metastasectomy, multiple site metastasis, time to metastasis <1.5 year, and increased corrected calcium were independent prognostic factors of OS. The low risk group (0–1 risk factors) did not reach the median OS, whereas the OS for the intermediate (2 risk factors) and high risk groups (3–5 risk factors) were 58.6 and 23.6 months, respectively (p<0.001). When a death event was considered the dependent factor, the area under the receiver operating characteristic curve was significantly higher than in the existing International mRCC Database Consortium (IMDC; p=0.010) and Memorial Sloan Kettering Cancer Center (MSKCC; p=0.010) risk criteria models.ConclusionInitial tumor size or T stage did not affect TTF or OS. Patients who could not undergo metastasectomy and rapidly developed multiple metastases with higher corrected calcium and initial tumors with sarcomatoid features were less likely to benefit from targeted therapy; thus, the new agents under development or clinical trials could be more helpful than the use of standard targeted agents.
Highlights
The surgical resection of localized renal cell carcinoma (RCC) results in a 5-year survival of approximately 90% [1]
Patients who could not undergo metastasectomy and rapidly developed multiple metastases with higher corrected calcium and initial tumors with sarcomatoid features were less likely to benefit from targeted therapy; the new agents under development or clinical trials could be more helpful than the use of standard targeted agents
Due to the high incidence of metastasis, the management of metastatic renal cell carcinoma (mRCC) has been revolutionized by therapeutic targeting of molecular pathways, which results in improved tumor response and prolonged survival [1]
Summary
The surgical resection of localized renal cell carcinoma (RCC) results in a 5-year survival of approximately 90% [1]. Due to the high incidence of metastasis, the management of mRCC has been revolutionized by therapeutic targeting of molecular pathways, which results in improved tumor response and prolonged survival [1]. The use of targeted agents has dramatically improved the prognosis of mRCC patients, complete remission rates remain poor and resistance to targeted therapies is high [4,5,6]. Several other treatment modalities including surgical resection (metastasectomy), radiotherapy, and classical immune therapy are still used to extend overall survival (OS). To assess the prognostic and predictive factors of time to treatment failure (TTF) and overall survival (OS), respectively, in patients with metachronous metastatic renal cell carcinoma (mRCC) who were treated with targeted agents
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