Among patients with metastatic renal cell carcinoma (mRCC), deferred cytoreductive nephrectomy (CN) might safely be offered to patients with a Memorial Sloan Kettering Cancer Center (MSKCC) intermediate-risk score but not to those with a poor-risk score, investigators reported at the 36th annual European Association of Urology virtual congress.
Julia Choy, MD, of Barts Cancer Institute in London, UK, and colleagues identified 112 patients with mRCC who underwent a deferred CN at a median 111.5 days following treatment with the targeted therapies sunitinib or pazopanib. Of these, 95 patients (84.8%) had MSKCC intermediate-risk disease and 17 (15.2%) poor-risk disease.
A total of 55 patients (49%) died. Median overall survival (OS) was significantly longer after surgery in patients with intermediate-risk compared with poor-risk disease: 31.28 vs 8.74 months, Dr Choy reported. The risk for death was 82% lower for the intermediate-risk group.
Patients without lymph node (LN) metastasis also had significantly longer median OS compared with patients who had lymph node involvement: 30.75 vs 19.84 months. On multivariable analysis, however, only MSKCC score remained significantly correlated with better OS, according to Dr Choy. Other preoperative factors, including age, sex, Karnofsky score, T stage, number of metastatic sites, bone involvement, primary tumor size, and median time to surgery, did not associate with OS.
“Ideal patient selection for deferred cytoreductive nephrectomy should therefore include an assessment of MSKCC risk score, with intermediate MSKCC risk disease identified as a favorable prognostic factor for survival following surgery,” Dr Choy concluded.
Choy J, Szabados B, Abu-Ghanem Y, Powles T, Wimalasingham A, Bex A. Optimizing patient selection for deferred cytoreductive nephrectomy in the contemporary era of targeted therapy. Presented at the EAU 2021 virtual conference, July 8-12, 2021. Abstract P0644.