Abstract
Patients without cytoreductive nephrectomy (CN) are inadequately represented in metastatic renal cell carcinoma (RCC) clinical trials. The characteristics that impact the decision of CN were explored in the SEER database. Data on primary, regional, or distant (metastatic) stage kidney cancer over the period 2000–2013 were extracted from the National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER-18) database. A sub-analysis of Metropolitan Detroit cases, to evaluate the influence of comorbidities, was conducted. Logistic regression was used to calculate the odds ratios, and Cox model was used to calculate hazard ratios; 37% of 21,052 metastatic RCC cases had CN performed. CN demonstrated significant survival advantage (HR = 0.31, 95% confidence interval [CI]: 0.30–0.33). Comorbidity data were available on 76% of distant RCC cases from the Detroit SEER database. Neither hypertension, diabetes mellitus nor the number of comorbidities (0, 1 or 2) had a statistically significant impact on the likelihood of CN. Majority of patients (63%) with distant-stage RCC do not undergo CN and have a median overall survival (OS) of 3 months as compared to a median OS of 18 months for patients who have undergone CN. Patient demographics and tumor characteristics make a significant impact on the incidence of CN. The impact of comorbidities (number and type) was modest and not statistically significant. The optimal management of patients with synchronous primary and metastatic RCC needs to be prospectively evaluated in the setting of contemporary systemic therapy.
Highlights
Cytoreductive nephrectomy (CN) in the presence of metastatic disease is a unique feature of the therapeutics of advanced renal cancer (RCC)
Patient demographics and tumor characteristics make a significant impact on the incidence of CN
The results of two randomized trials comparing CN followed by sunitinib versus systemic therapy with sunitinib followed by CN [SURTIME trial] and nephrectomy followed by sunitinib versus sunitinib alone (CARMENA) were recently reported
Summary
Cytoreductive nephrectomy (CN) in the presence of metastatic disease is a unique feature of the therapeutics of advanced renal cancer (RCC). CN in metastatic disease compared to systemic interferon therapy alone [1, 2]. The results of two randomized trials comparing CN followed by sunitinib versus systemic therapy with sunitinib followed by CN [SURTIME trial] and nephrectomy followed by sunitinib versus sunitinib alone (CARMENA) were recently reported. Both studies indicated that the clinical outcomes with sunitinib alone were at least similar and possibly slightly improved in the metastatic RCC patients randomized to deferred or no CN [4, 5]. The concept of CN being an essential component of metastatic RCC therapy is being seriously questioned. These data need to be considered in future therapeutic decisions in metastatic RCC
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