Improved survival after cytoreductive nephrectomy for metastatic renal cell carcinoma in the contemporary immunotherapy era: An analysis of the National Cancer Database Journal Article


Authors: Singla, N.; Hutchinson, R. C.; Ghandour, R. A.; Freifeld, Y.; Fang, D.; Sagalowsky, A. I.; Lotan, Y.; Bagrodia, A.; Margulis, V.; Hammers, H. J.; Woldu, S. L.
Article Title: Improved survival after cytoreductive nephrectomy for metastatic renal cell carcinoma in the contemporary immunotherapy era: An analysis of the National Cancer Database
Abstract: Objectives: Despite immune checkpoint inhibitor (ICI) approval for metastatic renal cell carcinoma (mRCC) in 2015, cytoreductive nephrectomy (CN) is guided by extrapolation from earlier classes of therapy. We evaluated survival outcomes, timing, and safety of combining CN with modern immunotherapy (IO) for mRCC. Methods: From 96,329 renal cancer cases reported to the NCDB between 2015 and 2016, we analyzed 391 surgical candidates diagnosed with clear cell mRCC treated with IO ± CN and no other systemic therapies. Primary outcome was overall survival (OS) stratified by the performance of CN (CN + IO vs. IO alone). Secondary outcomes included OS stratified by the timing of CN, pathologic findings, and perioperative outcomes. Results: Of 391 patients, 221 (56.5%) received CN + IO and 170 (43.5%) received IO only. Across a median follow-up of 14.7 months, patients who underwent CN + IO had superior OS (median NR vs. 11.6 months; hazard ratio 0.23, P < 0.001), which was upheld on multivariable analyses. IO before CN resulted in lower pT stage, grade, tumor size, and lymphovascular invasion rates compared to upfront CN. Two of 20 patients (10%) undergoing CN post-IO achieved complete pathologic response in the primary tumor (pT0). There were no positive surgical margins, 30-day readmissions, or prolonged length of stay in patients undergoing delayed CN. Conclusion: Using a large, national, registry-based cohort, we provide the first report of survival outcomes in mRCC patients treated with CN combined with modern IO. Our findings support an oncologic role for CN in the ICI era and provide preliminary evidence regarding the timing and safety of CN relative to IO administration. © 2020 Elsevier Inc.
Keywords: survival; immunotherapy; metastatic renal cell carcinoma; cytoreductive nephrectomy
Journal Title: Urologic Oncology: Seminars and Original Investigations
Volume: 38
Issue: 6
ISSN: 1078-1439
Publisher: Elsevier Inc.  
Date Published: 2020-06-01
Start Page: 604.e9
End Page: 604.e17
Language: English
DOI: 10.1016/j.urolonc.2020.02.029
PUBMED: 32253116
PROVIDER: scopus
PMCID: PMC7269798
DOI/URL:
Notes: Article -- Export Date: 3 August 2020 -- Source: Scopus
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  1. Nirmish Singla
    13 Singla