Meeting
2020 Genitourinary Cancers Symposium
Impact of metastasectomy on progression free and overall survival in metastatic renal cell carcinoma: Analysis of the REMARCC registry.
Authors
Margaret Frances Meagher
University of California San Diego, San Diego, CA
Margaret Frances Meagher , Ricardo Autorino , Maximilian Kriegmair , Maria Carmen Mir , Jose Rubio , Riccardo Campi , Andrea Mari , Matthias Heck , Francesco Porpiglia , Siska Van Bruwaene , Estefania Linares Espinos , Mireia Musquera , Fadi Ghali , Alessandro Veccia , Georgi Guruli , Eduard Rousel , Nicola Pavan , Alessandro Antonelli , Michele Marchioni , Ithaar Derweesh
Organizations
University of California San Diego, San Diego, CA, VCU Medical Center, Richmond, VA, Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany, University of Miami, Miami, FL, Instituto Valenciano de Oncologia, Valencia, Spain, Department of Urology, University of Florence, Careggi Hospital, Florence, Italy, 1988, Bagno A Ripoli, AP, Italy, Department of Urology, Klinikum rechts der Isar, TU München, Munich, Germany, Department of Urology, School of Medicine, University of Turin-San Luigi Gonzaga Hospital, Turin, Italy, AZ Groeninge, Kortrijk, Belgium, Department of Urology, Hospital Ramon y Cajal, Madrid, Spain, Department of Urology, University Health Network, Toronto, ON, Canada, Department of Urology, UC San Diego Moores Cancer Center, University of California San Diego School of Medicine, La Jolla, CA, Division of Urology, VCU Medical Center, Richmond, VA, Department of Urology- UKLeuven, Brussels, Belgium, University of Trieste, Miami, FL, Department of Urology; Azienda AO Spedali Civili di Brescia, Brescia, Italy, Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy
Research Funding
No funding received
None.
Background: The role of metastasectomy has been in flux as treatment paradigms for management of metastatic renal cell carcinoma (mRCC) have shifted. We examined outcomes of surgical metastasectomy stratified in the setting of different mRCC risk groups. Methods: Multicenter retrospective analysis of patients from the REMARCC (REgistry of MetAstatic RCC) database. The cohort was subdivided by Motzer RCC criteria (low, intermediate, and high risk), and impact of metastasectomy was analyzed via multivariable analysis (MVA) and Kaplan Meier analyses (KMA). Primary outcome was progression free survival (PFS) and secondary outcome was overall survival (OS). Results: 438 patients (46 low risk, 262 intermediate risk, 140 high risk) with median follow-up 16 months were analyzed. Metastasectomy was performed in 18 (39%), 63 (24%), and 32 (23%) of low, intermediate and high risk groups (p=0.04). Risk groups differed significantly with respect to ECOG performance status (p<0.001), metastases at diagnosis (low 1.72, intermediate 3.49, high 6.45, p<0.001), hemoglobin (p<0.001) and LDH (p<0.001). MVA for PFS revealed age (OR=1.03, p=0.05), BMI (OR=1.05, p=0.01), and higher risk category [vs. low (referent) intermediate OR=7.4, p<0.001, high OR=3.4, p=0.01] to be independent risk factors. MVA for OS revealed age (OR=1.03, p=0.02), BMI (OR=1.06, p=0.01), and higher risk category [low (referent) vs. intermediate OR=2.8, p=0.03, high OR=2.3, p=0.01] to be independent risk factors. KMA for PFS demonstrated that metastasectomy was associated with longer PFS in intermediate (24.0 vs. 6.7 months, p=0.01) but not high risk (4.2 vs. 4.0 months, p=0.58) and low risk (p=0.51) groups. KMA for OS demonstrated that metastasectomy was associated with longer median OS in the intermediate (56.9 vs. 29.3 months, p=0.01) and high risk (18.2 vs. 10.5, p=0.01), but not low risk (p=0.21) groups. Conclusions: Receipt of metastasectomy was associated with improved PFS in intermediate risk and improved OS in intermediate and high risk mRCC patients. These findings challenge prevailing assumptions about utility of metastasectomy. Further investigation is requisite to refine criteria for employment.
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Abstract Details
Session Type
Poster Session
Session Title
Poster Session C: Renal Cell Cancer
Track
Renal Cell Cancer
Sub Track
Other
Citation
J Clin Oncol 38, 2020 (suppl 6; abstr 753)
Abstract #
753
Poster Bd #
K9
Abstract Disclosures
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