Impact of cytoreductive nephrectomy (CN) on survival in metastatic renal cell cancer (mRCC) treated with immune checkpoint inhibitors (ICI).

Authors

null

Stuthi Perimbeti

Roswell Park Cancer Center, Buffalo, NY

Stuthi Perimbeti , Changchuan Jiang , Lei Deng , Arya Roy , Keerthy Gopalakrishnan , Gurkamal S. Chatta , Saby George , Dharmesh Gopalakrishnan

Organizations

Roswell Park Cancer Center, Buffalo, NY, Yale University, New Haven, NY, Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, University of Arkansas for Medical Sciences, Little Rock, AR, Roswellpark Cancer Institute, Buffalo, NY, Roswell Park Comprehensive Cancer Center, Buffalo, NY, Roswell Park Center, Buffalo, NY

Research Funding

No funding received

Background: The advent of ICIs has dramatically changed the treatment paradigm in mRCC. Although CN was demonstrated to improve survival in combination with cytokine-based therapies, its role is not well-defined in the ICI era. We aimed to compare survival outcomes of patients treated with ICIs, based on their CN status. Methods: The National Cancer Database was queried to identify all patients older than 18 years with mRCC who received ICIs from 2015 to 2018. Chi-Square and Mann-Whitney U tests were used to compare frequency distributions. Cox proportional hazards regression was employed for multivariate analysis of factors associated with overall survival (OS). Results: A total of 4,369 patients were identified- 36.4% (n=1589) had undergone CN. Among patients who got CN, 85.3% were treated with upfront surgery while 13.8% received prior systemic therapy (P = 0.001). The study population was predominantly Caucasian (89.2%) and male (70.6%). Patients who underwent CN were younger (median age 61 vs. 65 years, P = <0.001). Large primary tumors and clinically node-negative status were associated with higher odds of CN (T4 disease - odds ratio (OR) for 1.49, 95% CI 1.13-3.44, P = 0.03; cN0 disease - OR 1.56, 95% CI 1.23-4.56, P = 0.04). OS after 1 year was significantly higher in patients who underwent CN (66.8% vs 33.2%. P <0.001). On multivariate analysis, CN was independently predictive of improved OS with a hazard ratio (HR) of 0.53 and 95% CI 0.41-0.68, P<0.001. Conclusions: In this large retrospective analysis, CN was associated with improved OS among patients with mRCC receiving ICI-based therapies. Our findings suggest that despite recent advances in systemic therapies for mRCC, CN retains an important role in carefully selected patients.

Variable
Univariate HR for mortality (95% CI)
p-value
Multivariate HR for mortality (95% CI)
p-value
ICI + CN vs.

ICI alone
0.42 (0.36-0.47)
0.001
0.53 (0.41-0.68)
<0.001
Age group

(51-65 vs. 18-35y)
0.47 (0.31-0.72)
0.001
0.61 (0.40-0.90)
<0.001
AA vs. White
1.45 (1.19-1.76)
0.001
1.24 (1.01-1.52)
0.03
≥2 vs. 0 comorbidities
1.30 (1.15-1.52)
0.001
1.24 (1.06-1.46)
0.0001
Median annual income <$30,000 vs. >$46,000
1.44 (1.20-1.72)
0.001
1.30 (1.08-1.57)
0.004

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2022 ASCO Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Renal Cell Cancer; Adrenal, Penile, Urethral, and Testicular Cancers

Track

Renal Cell Cancer,Adrenal Cancer,Penile Cancer,Testicular Cancer,Urethral Cancer

Sub Track

Therapeutics

Citation

J Clin Oncol 40, 2022 (suppl 6; abstr 359)

DOI

10.1200/JCO.2022.40.6_suppl.359

Abstract #

359

Poster Bd #

L10

Abstract Disclosures

Similar Abstracts

First Author: Renee Maria Saliby

Abstract

2020 Genitourinary Cancers Symposium

Association of cytoreductive nephrectomy and survival in the immune checkpoint inhibitor era.

First Author: Joseph Miccio