Predictors of Cytoreductive Nephrectomy for Metastatic Kidney Cancer in SEER and Metropolitan Detroit Databases

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Ulka Vaishampayan, MD
Julie George
Fawn Vigneau

Keywords

Abstract

Patients without cytoreductive nephrectomy (CN) are inadequately represented in metastatic 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% CI: 0.30-0.33). Comorbidity data was 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 OS of 3 months as compared to median OS of 18 months for cases with CN. Patient demographics and tumor characteristics make a significant impact on 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.


 

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References

1. Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V, McGrath PC et al: Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. New England Journal of Medicine 2001; 345:1655-9.

2. Mickisch G, Garin A, Van Poppel H,: de Prijck L, Sylvester R; Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet 2001; 358:966-70.

3. Graham J, Heng DYC, Brugarolas J, Vaishampayan U. Personalized Management of Advanced Kidney Cancer. Am Soc Clin Oncol Educ Book. 2018 May 23;(38):330-341

4. Bex A, et al. Immediate versus deferred cytoreductive nephrectomy (CN) in patients with synchronous metastatic renal cell carcinoma (mRCC) receiving sunitinib (EORTC 30073 SURTIME). ESMO 2017, Late breaking abstract # 35

5. Méjean A, Ravaud A, Thezenas S, Colas S, Beauval JB, Bensalah K et al. Sunitinib Alone or after Nephrectomy in Metastatic Renal-Cell Carcinoma. N Engl J Med. 2018;379(5):417-427.

6. Hanna N, Sun M, Meyer CP, et al. Survival Analyses of Patients With Metastatic Renal Cancer Treated With Targeted Therapy With or Without Cytoreductive Nephrectomy: A National Cancer Data Base Study. J Clin Oncol. 2016;34(27):3267-75.

7. Vaishampayan U, Vankayala H, Vigneau FD, et al. The effect of targeted therapy on overall survival in advanced renal cancer: a study of the national surveillance epidemiology and end results registry database. Clin Genitourin Cancer. 2014 Apr;12(2):124-9.

8. Tripathi RT, Heilbrun LK, Jain V, Vaishampayan UN. Racial disparity in outcomes of a clinical trial population with metastatic renal cell carcinoma.Urology. 2006 Aug;68(2):296-301.

9. Heng DY, Wells JC, Rini BI, et al. Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol. 2014 Oct;66(4):704-10.

10. Harshman LC, Drake CG, Choueiri TK. PD-1 blockade in renal cell carcinoma: to equilibrium and beyond. Cancer Immunol Res. 2014 Dec;2(12):1132-41.