Pd18-09 the Role of Cytoreductive Nephrectomy in Contemporary Metastatic Renal Cell Carcinoma: An Other-Cause Mortality Match Population-Based Study

You have accessJournal of UrologyKidney Cancer: Advanced (Including Drug Therapy) II (PD18)1 May 2024PD18-09 THE ROLE OF CYTOREDUCTIVE NEPHRECTOMY IN CONTEMPORARY METASTATIC RENAL CELL CARCINOMA: AN OTHER-CAUSE MORTALITY MATCH POPULATION-BASED STUDY Marco Finati, Giuseppe O. Cirulli, Giuseppe Chiarelli, Alex Stephens, Shane Tinsley, Mohit Butaney, Sohrab Arora, Akshay Sood, Nicolò Buffi, Giovanni Lughezzani, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Gian Maria Busetto, Giuseppe Carrieri, Craig Rogers, and Firas Abdollah Marco FinatiMarco Finati , Giuseppe O. CirulliGiuseppe O. Cirulli , Giuseppe ChiarelliGiuseppe Chiarelli , Alex StephensAlex Stephens , Shane TinsleyShane Tinsley , Mohit ButaneyMohit Butaney , Sohrab AroraSohrab Arora , Akshay SoodAkshay Sood , Nicolò BuffiNicolò Buffi , Giovanni LughezzaniGiovanni Lughezzani , Andrea SaloniaAndrea Salonia , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Gian Maria BusettoGian Maria Busetto , Giuseppe CarrieriGiuseppe Carrieri , Craig RogersCraig Rogers , and Firas AbdollahFiras Abdollah View All Author Informationhttps://doi.org/10.1097/01.JU.0001008596.32809.c5.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The CARMENA trial showed no overall survival advatange after cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (RCC) patients previously treated with Sunitinib. However, this trial raised concerns about generalizability due to recruitment bias of patients with higher metastatic burden than usual clinical scenario. Contrarywise, observational studies how patients referred to CN generally have better health and lower all-cause mortality. Our study aimed to evaluates the impact of CN on cancer-specific mortality (CSM) over a cohort of metastatic RCC patients matched for other-cause mortality (OCM) METHODS: Patients>18 years with metastatic RCC (2010-2017) were identified from the SEER database. We included only those treated with immunotherapy. A Cox regression model was used to calculate the other-cause mortality (OCM) risk. Therefore, a 1:1 (CN versus no surgery on the primary site) propensity score match was used to create a homogeneous cohort with the same OCM risk. Cumulative incidence curves depicted CSM and OCM rates, while Fine-Gray regression tested the impact of CN vs no surgery on CSM in the matched cohort. Patients were further stratified according to number of metastasis site. RESULTS: We identified 3138 immunotreated metastatic RCC patients, of whom 1597 (51%) underwent CN. In the unmatched cohort, 3-years CSM and OCM rates were 80.8% and 15.5% for non-surgery arm respectively, versus 54.3% and 80.8% for CN (all p<0.001). Our match yielded to 1662 patients equally distributed between CN and no surgery arm, with no difference in OCM rate (11.7% vs 10.8%, p=0.8). In the matched cohort, the 3-years CSM was 54.1% for patients who underwent CN versus 80.3% in non-surgery arm (p<0.001). At multivariable analyses, patients who did not receive surgery had 1.79-fold higher risk of CSM, when compared with those who underwent CN (95% CI: 1.56-2.06, p<0.001). When stratified patients for number of metastases sites, non-surgery arm was associated with higher CSM rates for patients with 1 (84.5% vs 70.0%) or 2 metastases sites (87.8% vs 73.4%, all p<0.001). Conversely, no difference in CSM were observed for 3 or more sites, regardless of CN receipt (89.1% vs 86.8%, p=0.06) CONCLUSIONS: Our novel methodology matched a cohort of metastatic immuno-treated RCC with no difference in OCM as a proxy of comparable health status. In this setting, we showed how CN provided a CSM advantage for patients with low-to-intermediate metastatic burden. Conversely, this advantage was not observed in case of widespread metastases. Source of Funding: Vattikuti Foundation and Menon Foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e436 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Marco Finati More articles by this author Giuseppe O. Cirulli More articles by this author Giuseppe Chiarelli More articles by this author Alex Stephens More articles by this author Shane Tinsley More articles by this author Mohit Butaney More articles by this author Sohrab Arora More articles by this author Akshay Sood More articles by this author Nicolò Buffi More articles by this author Giovanni Lughezzani More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Gian Maria Busetto More articles by this author Giuseppe Carrieri More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...