Abstract
PurposeWe aimed to determine the prognostic significance of computed tomography imaging parameters of unresectable primary renal tumor lesions, obtained at baseline and at first follow-up, on overall survival in naïve, unresectable metastatic renal cell carcinoma patients during first-line systemic therapy.Materials and methodsClinicopathological parameters of 56 patients treated between 2007 and 2015, including imaging parameters (such as the longest tumor diameter, necrotic area diameter, and attenuation in primary renal tumor lesions on baseline vs. follow-up computed tomography), were retrospectively reviewed to derive predictive factors of overall survival. The best overall response was measured according to the RECIST v1.1.ResultsThe median treatment period was 206.3 days and the median follow-up was 14.6 months. Forty-four (78.6%) patients progressed after a median 4.6 months of progression-free survival, and 6 (10.7%) patients survived with a median overall survival of 12.5 months. Multivariate analysis showed that the baseline tumor diameter (hazard ratio [HR] 0.903) and mean attenuation (HR 0.936), change of tumor diameter (HR 0.714) and necrosis diameter (HR 0.861), change in the percentage of tumor diameter (HR 1.483) and of necrosis diameter (HR 1.028) between baseline and follow-up computed tomography images; treatment duration (HR 0.986) and baseline serum hemoglobin (HR 1.790) and albumin level (HR 0.060) were significant factors for overall survival (p<0.05).ConclusionThe study showed that baseline and first follow-up computed tomography findings of primary renal lesions during first-line systemic therapy are useful and significant predictors of OS in patients with naïve unresectable mRCC.
Highlights
Over the past 2 decades, the advent of molecular targeting agents has greatly improved the prognoses of advanced renal cell carcinoma (RCC), producing higher therapeutic response rates as well as longer progression-free survival (PFS) and overall survival (OS) compared to those of previous immunotherapeutic strategies [1,2]
Multivariate analysis showed that the baseline tumor diameter and mean attenuation (HR 0.936), change of tumor diameter (HR 0.714) and necrosis diameter (HR 0.861), change in the percentage of tumor diameter (HR 1.483) and of necrosis diameter (HR 1.028) between baseline and follow-up computed tomography images; treatment duration (HR 0.986) and baseline serum hemoglobin (HR 1.790) and albumin level (HR 0.060) were significant factors for overall survival (p
The study showed that baseline and first follow-up computed tomography findings of primary renal lesions during first-line systemic therapy are useful and significant predictors of OS in patients with naïve unresectable metastatic RCC (mRCC)
Summary
Over the past 2 decades, the advent of molecular targeting agents has greatly improved the prognoses of advanced renal cell carcinoma (RCC), producing higher therapeutic response rates as well as longer progression-free survival (PFS) and overall survival (OS) compared to those of previous immunotherapeutic strategies [1,2]. The standard treatment has shifted from immunotherapy (IT) to targeted therapy (TT), in which interferon (IFN)-α in combination with other TTs and interleukin (IL)-2 alone are utilized as first-line systemic therapies in selected metastatic RCC (mRCC) patients [3]. In advanced RCC, patients with unresectable mRCC reportedly have worse OS rates than those that undergo cytoreductive nephrectomy combined with either IT or TT (IT and TT without cytoreductive nephrectomy: 3 and 13 months, respectively; compared to IT and TT with cytoreductive nephrectomy: 4 and 19 months, respectively) [5]. To better estimate the prognoses of naïve unresectable mRCC patients, several prognostic models for mRCC as well as known significant predictive factors for OS have been used by clinicians for the purposes of selecting patients more likely to benefit from ongoing therapy, promptly preparing additional therapeutic plans with more accurate first-line therapy evaluation tools, and saving time by initiating subsequent therapy earlier within the treatment window
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