Along with preventing metastatic spread and permitting treatment cessation, cytoreductive nephrectomy may improve patients’ quality of life, investigators reported at the American Urological Association’s 2023 Annual Meeting in Chicago, Illinois.
Daniel Shapiro, MD, of the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues quantified the effects of cytoreductive nephrectomy on quality of life in a pilot study of 25 patients with metastatic renal cell carcinoma, 76% clear cell, 84% T3-T4, 96% grade 3-4. A total of 13% of patients had 3 or more metastatic sites. Three-quarters of patients were White race and two-thirds were male.
Patients completed the functional assessment of cancer therapy kidney symptom index (FKSI-19) before and after cytoreductive nephrectomy. The 19-item questionnaire includes 12 items on physical symptoms, 1 item on emotional symptoms, 3 items on treatment-related side effects, and 3 items on functional wellbeing. Total scores range from 0-76 with higher scores indicating fewer symptoms.
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Median preop and postop FKSI scores did not differ significantly: 57 vs 59. Among the domains, the emotional score significantly improved after surgery: median 2 vs 3 out of a total of 4 points, which indicates that patients were less worried their cancer would progress after cytoreductive nephrectomy, Dr Shapiro said in an interview.
Of the 25 patients, 11 (44%) had a clinically meaningful 5-point improvement in FKSI score after surgery. Patients with the most symptoms prior to surgery experienced the largest improvement in FKSI score, Dr Shapiro reported. Patients with low preop FKSI scores had significant 11% increased odds of clinically meaningful postop improvement.
“The average overall FKSI score prior to cytoreductive nephrectomy in this study was lower than typical phase 3 trials of systemic therapy for metastatic RCC indicating that we’re offering surgery to the most symptomatic patients,” he said.
Tumor size, gender, surgical approach, age, and race were not associated with change in FKSI postoperatively. Postsurgical systemic therapy was prescribed for 79% of patients.
“This study demonstrates the potential physical and emotional impact that cytoreductive nephrectomy may have on patient reported outcomes and supports the use of cytoreductive nephrectomy in appropriately selected patients in the era of modern immune checkpoint inhibitor therapies,” Dr Shapiro said.
The FKSI was administered 4-6 weeks after surgery. The timing of the postoperative FKSI questionnaire may have influenced results.
“Since the FKSI allows an objective assessment of symptoms it may be tracked over time and aid multidisciplinary decision making.”
The study is ongoing. “As we continue to expand data collection for patient reported outcomes after cytoreductive surgery, we hope to improve surgical selection,” Dr Shapiro said.
Reference
Shapiro D, Master V, Craig J, et al. Impact of cytoreductive nephrectomy on patient-reported outcomes. Presented at: AUA 2023, Chicago, Illinois, April 28-May 1. Poster PD43-11.
