Roswell Park Cancer Center, Buffalo, NY
Stuthi Perimbeti , Changchuan Jiang , Lei Deng , Arya Roy , Keerthy Gopalakrishnan , Gurkamal S. Chatta , Saby George , Dharmesh Gopalakrishnan
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 |
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