Abstract
BackgroundThe differences in progression-free survival (PFS) and cancer-specific survival (CSS) of metastatic renal cell carcinoma (mRCC) patients according to treatment, type of metastasis, and Heng criteria risk are unclear. In this study, we compared survival according to various such parameters.MethodsBetween 2000 to 2014, 214 mRCC patients, of whom 171 (79.9%) were intermediate-risk and 43 (20.1%) were poor-risk, were retrospectively selected; 126 (58.9%) patients were treated with immunotherapy (IT) and 88 (41.1%) with targeted therapy (TT). Moreover, 144 patients had synchronous mRCCs (67.3%, SM) and 70 had metachronous mRCCs (32.7%, MM). The Kaplan-Meier method and log-rank test were used to compare progression-free survival (PFS) and CSS.ResultsDuring a median 4.2 (1.0–70.4) months of systemic treatment and 98.3 (4.8–147.6) months of follow-up, the median PFS and CSS were 4.7 (95% confidence interval [CI]: 3.8–5.5) and 13.8 (95% CI, 9.8–18.3) months, respectively. The PFS and CSS were significantly better in the MM (5.9 and 21.3 months) and intermediate-risk groups (5.2 and 18.3 months) than those in the SM (4.4 and 9.6 months) and poor-risk groups (2.7 and 5.8 months), respectively (p < 0.05). Further stratification showed that TT produced significantly better PFS than IT in intermediate-risk patients with SM and a treatment-free interval (TFI) < 1 year, and in those with MM with a TFI ≥1 year (p < 0.05). There were no differences in survival outcomes according to various other subgroup stratifications (p > 0.05).ConclusionDividing patients into specific subcategories helps to better predict therapeutic outcomes.
Highlights
The differences in progression-free survival (PFS) and cancer-specific survival (CSS) of metastatic renal cell carcinoma patients according to treatment, type of metastasis, and Heng criteria risk are unclear
The gender ratio, nephrectomy rates, treatment-free interval (TFI), Heng risk groups, clinical T and N stages, clear cell and nonclear cell histologies, follow-up durations, PFS, and CSS were significantly different between the synchronous metastatic renal cell carcinoma (mRCC) (SM) and MM groups (p < 0.05, Table 2)
Our study showed that dividing patients into additional subcategories improved the prediction of therapeutic outcomes
Summary
The differences in progression-free survival (PFS) and cancer-specific survival (CSS) of metastatic renal cell carcinoma (mRCC) patients according to treatment, type of metastasis, and Heng criteria risk are unclear. The TT treatment guidelines for MM and SM are similar, and not many studies have addressed the differential prognoses and comparative responses between TT and IT according to the tumors’ metastatic types and prognostic risk groups Such clinical data regarding survival outcomes are required for clinicians to understand the patients’ prognoses and to devise effective treatment strategies. This retrospective study analyzed the PFS and CSS according to first-line systemic therapy, as well as the survival rates of patients with MM or SM mRCCs treated with either TT or IT at a single institution. Prognostic outcomes according to the types of metastases were compared with respect to the Heng risk model and treatment-free intervals (TFIs)
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