The Association Between Cytoreductive Nephrectomy and Overall Survival in Metastatic Renal Cell Carcinoma with Primary Tumor Size ≤4 cm

TY - JOUR

T1 - The Association Between Cytoreductive Nephrectomy and Overall Survival in Metastatic Renal Cell Carcinoma with Primary Tumor Size ≤4 cm

AU - Tappero, Stefano

AU - Barletta, Francesco

AU - Piccinelli, Mattia Luca

AU - Cano Garcia, Cristina

AU - Incesu, Reha-Baris

AU - Morra, Simone

AU - Scheipner, Lukas

AU - Tian, Zhe

AU - Parodi, Stefano

AU - Dell'Oglio, Paolo

AU - Palumbo, Carlotta

AU - Briganti, Alberto

AU - De Cobelli, Ottavio

AU - Chun, Felix K H

AU - Graefen, Markus

AU - Longo, Nicola

AU - Ahyai, Sascha

AU - Saad, Fred

AU - Shariat, Shahrokh F

AU - Suardi, Nazareno

AU - Borghesi, Marco

AU - Terrone, Carlo

AU - Karakiewicz, Pierre I

N1 - Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2023/9

Y1 - 2023/9

N2 - BACKGROUND: It is unknown whether the survival benefit of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) applies to patients with primary tumor size ≤4 cm.OBJECTIVE: To test the association between CN on overall survival (OS) of mRCC patients with primary tumor size ≤4 cm.DESIGN, SETTING, AND PARTICIPANTS: Within the Surveillance, Epidemiology, and End Results (SEER) database (2006-2018), all mRCC patients with primary tumor size ≤4 cm were identified.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Propensity score matching (PSM), Kaplan-Meier plots, multivariable Cox regression analyses, and 6-mo landmark analyses addressed OS according to CN status. Sensitivity analyses examined specific populations of special interest: systemic therapy exposed versus naïve, clear-cell (ccmRCC) versus non-clear-cell (non-ccmRCC) mRCC histology, historical (2006-2012) versus contemporary (2013-2018), and young (≤65 yr) versus old (>65 yr) patients.RESULTS AND LIMITATIONS: Of 814 patients, 387 (48%) underwent CN. After PSM, the median OS was 44 versus 7 mo (Δ = 37 mo; p < 0.001) in CN versus no-CN patients. CN was associated with higher OS in overall population (multivariable hazard ratio [HR]: 0.30; p < 0.001) as well as in landmark analyses (HR: 0.39; p < 0.001). In all sensitivity analyses, CN was independently associated with higher OS: systemic therapy exposed, HR: 0.38; systemic therapy naïve, HR: 0.31; ccmRCC, HR: 0.29; non-ccmRCC, HR: 0.37; historical, HR: 0.31; contemporary, HR: 0.30; young, HR: 0.23; and old, HR: 0.39 (all p < 0.001).CONCLUSIONS: The current study validates the association between CN and higher OS in patients with primary tumor size ≤4 cm. This association is robust, controlled for immortal time bias, and valid across systemic treatment exposure, histologic subtypes, years of surgery, and patient age.PATIENT SUMMARY: In the current study, we tested the association between cytoreductive nephrectomy (CN) and overall survival in patients with metastatic renal cell carcinoma and small primary tumor size. We found a strong association between CN and survival, which persists even after several significant variations in patient and tumor characteristics.

AB - BACKGROUND: It is unknown whether the survival benefit of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) applies to patients with primary tumor size ≤4 cm.OBJECTIVE: To test the association between CN on overall survival (OS) of mRCC patients with primary tumor size ≤4 cm.DESIGN, SETTING, AND PARTICIPANTS: Within the Surveillance, Epidemiology, and End Results (SEER) database (2006-2018), all mRCC patients with primary tumor size ≤4 cm were identified.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Propensity score matching (PSM), Kaplan-Meier plots, multivariable Cox regression analyses, and 6-mo landmark analyses addressed OS according to CN status. Sensitivity analyses examined specific populations of special interest: systemic therapy exposed versus naïve, clear-cell (ccmRCC) versus non-clear-cell (non-ccmRCC) mRCC histology, historical (2006-2012) versus contemporary (2013-2018), and young (≤65 yr) versus old (>65 yr) patients.RESULTS AND LIMITATIONS: Of 814 patients, 387 (48%) underwent CN. After PSM, the median OS was 44 versus 7 mo (Δ = 37 mo; p < 0.001) in CN versus no-CN patients. CN was associated with higher OS in overall population (multivariable hazard ratio [HR]: 0.30; p < 0.001) as well as in landmark analyses (HR: 0.39; p < 0.001). In all sensitivity analyses, CN was independently associated with higher OS: systemic therapy exposed, HR: 0.38; systemic therapy naïve, HR: 0.31; ccmRCC, HR: 0.29; non-ccmRCC, HR: 0.37; historical, HR: 0.31; contemporary, HR: 0.30; young, HR: 0.23; and old, HR: 0.39 (all p < 0.001).CONCLUSIONS: The current study validates the association between CN and higher OS in patients with primary tumor size ≤4 cm. This association is robust, controlled for immortal time bias, and valid across systemic treatment exposure, histologic subtypes, years of surgery, and patient age.PATIENT SUMMARY: In the current study, we tested the association between cytoreductive nephrectomy (CN) and overall survival in patients with metastatic renal cell carcinoma and small primary tumor size. We found a strong association between CN and survival, which persists even after several significant variations in patient and tumor characteristics.

KW - Humans

KW - Carcinoma, Renal Cell/pathology

KW - Kidney Neoplasms/pathology

KW - Cytoreduction Surgical Procedures/methods

KW - Nephrectomy/methods

KW - Proportional Hazards Models

U2 - 10.1016/j.euf.2023.02.010

DO - 10.1016/j.euf.2023.02.010

M3 - SCORING: Journal article

C2 - 36906483

VL - 9

SP - 742

EP - 750

JO - EUR UROL FOCUS

JF - EUR UROL FOCUS

SN - 2405-4569

IS - 5

ER -