Cytoreductive nephrectomy (CN) improves survival in patients with metastatic renal cell carcinoma (mRCC) receiving modern immunotherapy, according to study findings presented at the 20th annual meeting of the Society of Urologic Oncology in Washington, DC.
Nirmish Singla, MD, MSCS, of the University of Texas Southwestern Medical Center in Dallas, and colleagues studied 391 patients diagnosed with mRCC between 2015 and 2016 who were identified using the National Cancer Data Base (NCDB). Of these, 221 (56.5%) received both CN and immunotherapy and 170 (43.5%) received immunotherapy only. Of the 221 patients who received both treatments, 197 had upfront CN prior to immunotherapy and 24 received immunotherapy prior to CN. The median follow-up was 14.7 months among 183 patients with available survival data.
Patients who underwent CN plus immunotherapy had a significant 77% decreased risk of death compared with the immunotherapy-only group. Immunotherapy given prior to CN resulted in lower pT stage, Fuhrman grade, tumor size, and frequency of lymphovascular invasion compared with upfront CN, Dr Singla’s team reported.
The investigators observed no positive surgical margins, 30-day readmissions, or prolonged inpatient length-of-stay among patients undergoing delayed CN after immunotherapy.
“This retrospective analysis must be interpreted within the context of limitations and biases inherent to the NCDB,” Dr Singla told Renal & Urology News. “However, our findings support an oncologic role for CN in the modern IO [immunotherapy] era and provide preliminary evidence regarding the timing and safety of CN relative to IO administration. Prospective validation is indeed warranted.”
Singla N, Hutchinson R, Ghandour R, et al. Improved survival after cytoreductive nephrectomy for metastatic renal cell carcinoma in the contemporary immunotherapy era: A national population-based analysis. Presented at the Society of Urologic Oncology 20th annual meeting held December 4 to 6 in Washington, DC. Poster 43.