Prognostic factors for survival in patients undergoing surveillance after cytoreductive nephrectomy Journal Article
| Authors: | Reese, S. W.; Khaleel, S.; Silagy, A.; Xie, A.; Eismann, L.; Vazquez-Rivera, K.; Oparanozie, A.; Patil, S.; Coleman, J.; Motzer, R.; Kotecha, R. R.; Russo, P.; Voss, M. H.; Hakimi, A. A. |
| Article Title: | Prognostic factors for survival in patients undergoing surveillance after cytoreductive nephrectomy |
| Abstract: | Purpose:The clinical course of patients being placed on surveillance in a cohort of systemic therapy-naïve patients who undergo cytoreductive nephrectomy is not well documented. Thus, we evaluated the clinical course of patients placed on surveillance following cytoreductive nephrectomy and identified predictors of survival.Materials and Methods:In this large single-institution study, we retrospectively analyzed metastatic renal cell carcinoma patients who underwent cytoreductive nephrectomy followed by surveillance. Predictors of survival were evaluated using the Kaplan-Meier method with a log-rank test. Patients were risk stratified based on IMDC (International mRCC Database Consortium) and number of metastatic sites (Rini score), with IMDC score ≤1 and ≤2 metastatic organ sites considered favorable risk. Primary end point was systemic therapy-free survival. Secondary end points included intervention-free survival, cancer-specific survival, and overall survival.Results:Median systemic therapy-free survival was 23.6 months (95% CI: 15.1-40.6), intervention-free survival was 11.8 months (95% CI: 8.0-18.4), cancer-specific survival was 54.2 months (95% CI: 46.2-71.4), and overall survival 52.4 months (95% CI: 40.3-66.8). Favorable-risk patients compared to unfavorable-risk patients had longer systemic therapy-free survival (50.6 vs 11.1 months, P <.01), survival (25.2 vs 7.3, P <.01), and cancer-specific survival (71.4 vs 46.2 months, P =.02).Conclusions:Using risk stratification based on IMDC and number of metastatic sites, surveillance in favorable-risk patients can be utilized for a period without the initiation of systemic therapy. This approach can delay patients' exposure to the side effects of systemic therapy. © 2023 Lippincott Williams and Wilkins. All rights reserved. |
| Keywords: | cancer survival; controlled study; aged; retrospective studies; major clinical study; overall survival; disease course; systemic therapy; outcome assessment; cytoreductive surgery; metastasis; cohort analysis; pathology; retrospective study; renal cell carcinoma; kidney neoplasms; nephrectomy; lung metastasis; kidney tumor; carcinoma, renal cell; disease progression; watchful waiting; cancer specific survival; carcinoma; cancer epidemiology; kaplan meier method; disease exacerbation; metastasectomy; renal cell; clear cell renal cell carcinoma; metastatic renal cell carcinoma; procedures; survival prediction; cancer prognosis; charlson comorbidity index; humans; prognosis; human; male; female; article; cytoreduction surgical procedures; cytroreduction surgical procedures |
| Journal Title: | Journal of Urology |
| Volume: | 210 |
| Issue: | 2 |
| ISSN: | 0022-5347 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2023-08-01 |
| Start Page: | 273 |
| End Page: | 279 |
| Language: | English |
| DOI: | 10.1097/ju.0000000000003549 |
| PUBMED: | 37167628 |
| PROVIDER: | scopus |
| PMCID: | PMC10726735 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- MSK corresponding author is A. Hakimi -- Source: Scopus |
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