JU INSIGHT Prognostic Factors for Survival in Patients Undergoing Surveillance After Cytoreductive Nephrectomy

By: Stephen W. Reese, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Sari Khaleel, MD, MS, Memorial Sloan Kettering Cancer Center, New York, New York; Andrew Silagy, MD, PhD, Memorial Sloan Kettering Cancer Center, New York, New York; Amy Xie, BA, Memorial Sloan Kettering Cancer Center, New York, New York; Lennert Eismann, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Katiana Vazquez-Rivera, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Arnold Oparanozie, BA, Memorial Sloan Kettering Cancer Center, New York, New York; Sujata Patil, PhD, MPH, MS, Ludwig-Maximilians University, Munich, Germany, Cleveland Clinic, Ohio; Jonathan Coleman, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Robert Motzer, MD, Ludwig-Maximilians University, Munich, Germany, Memorial Sloan Kettering Cancer Center, New York, New York; Ritesh R. Kotecha, MD, Ludwig-Maximilians University, Munich, Germany, Memorial Sloan Kettering Cancer Center, New York, New York; Paul Russo, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Martin H. Voss, MD, Ludwig-Maximilians University, Munich, Germany, Memorial Sloan Kettering Cancer Center, New York, New York; A. Ari Hakimi, MD, Memorial Sloan Kettering Cancer Center, New York, New York | Posted on: 30 Aug 2023

Reese SW, Khaleel S, Silagy A, et al. Prognostic factors for survival in patients undergoing surveillance after cytoreductive nephrectomy. J Urol. 2023;210(2):273-279.

Study Need and Importance

A group of patients with metastatic renal cell carcinoma (mRCC) who undergo cytoreductive nephrectomy can be placed on surveillance as opposed to directly receiving systemic therapy. However, there is limited information available regarding the clinical outcomes and predictors of survival in this group of patients. Thus, we performed a single-center retrospective review of patients placed on surveillance after cytoreduction to assess outcomes and identify predictors of survival.

What We Found

We identified 92 patients who underwent cytoreductive nephrectomy and then were placed on surveillance. Systemic therapy–free, intervention-free, cancer-specific, and overall survival were identified. Predictors of systemic therapy–free survival were examined, and the most promising predictors were the presence of ≤1 IMDC (International mRCC Database Consortium) risk factors and ≤2 metastatic organ sites at the time of surgery. Patients with a favorable risk score had longer systemic therapy–free survival (50.6 vs 11.1 months, P < .01), intervention-free survival (25.2 vs 7.3 months, P < .01), and cancer-specific survival (71.4 vs 46.2 months, P = .02; see Figure).

Limitations

Given the retrospective nature of the study, we were unable to identify additional points of stratification like underlying tumor biology to help identify ideal patients for surveillance. Additionally, we could not prospectively and/or more precisely define the criteria about starting a patient on surveillance vs initiating systemic therapy.

Interpretation for Patient Care

A subset of patients with mRCC who undergo cytoreductive nephrectomy may be considered for surveillance as opposed to receiving up-front systemic therapy. Patients who demonstrate ≤1 IMDC risk factor and ≤2 metastatic organ sites may be the best candidates for surveillance as these patients demonstrate the best survival outcomes. This may be an important strategy to limit treatment related toxicities associated with systemic therapy.

Figure. Kaplan-Meier survival estimates for systemic therapy–free survival (ST-FS), intervention-free survival (IFS), cancer-specific survival (CSS), and overall survival (OS). IMDC indicates International mRCC Database Consortium; NR, not reached.