Outcome of patients with metastatic renal cell carcinoma treated with targeted therapy without cytoreductive nephrectomy.
BACKGROUND
Cytoreductive nephrectomy (CN) became a standard procedure in metastatic renal cell carcinoma (mRCC) in the immunotherapy era. Historically, median overall survival (OS) of patients treated with interferon alpha (IFN-α) without CN was 7.8 months. Median OS in patients treated with targeted therapy (TT) without CN is unknown.


METHODS
We retrospectively reviewed records of patients with mRCC who received TT without CN. Kaplan-Meier methods and Cox regression analysis were used to estimate median OS and identify poor prognostic factors.


RESULTS
One hundred and eighty-eight patients were identified. Most patients had intermediate-risk (54.8%) or poor-risk (44.1%) disease. Median OS for all patients was 10.4 months [95% confidence interval (CI) 8.1-12.5]. By multivariable analysis, elevated baseline lactate dehydrogenase and corrected calcium, performance status of two or more, retroperitoneal nodal metastasis, thrombocytosis, current smoking, two or more metastatic sites, and lymphopenia were independent risk factors for inferior OS. Patients with four or more factors had increased risk of death (hazard ratio 8.83, 95% CI 5.02-15.5, P < 0.001) and 5.5-month median OS. Nineteen patients (10.0%) survived for 2+ years.


CONCLUSIONS
These data highlight the improved OS of patients with mRCC treated with TT without CN, compared with historical IFN-α treatment, and may guide the design of trials investigating the role of CN in the TT era.
Department of Genitourinary Medical Oncology.
S L
SL
Richey
Department of Urology.
S H
SH
Culp
Department of Genitourinary Medical Oncology.
E
E
Jonasch
Department of Genitourinary Medical Oncology.
P G
PG
Corn
Department of Genitourinary Medical Oncology.
L C
LC
Pagliaro
Department of Pathology, The University of Texas MD Anderson Cancer Center.
P
P
Tamboli
Department of Internal Medicine, The University of Texas Health Science Center, Houston, USA.
K K
KK
Patel
Department of Urology.
S F
SF
Matin
Department of Urology.
C G
CG
Wood
Department of Genitourinary Medical Oncology. Electronic address: ntannir@mdanderson.org.
N M
NM
Tannir
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009392:Nephrectomy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents