Patients with metastatic renal cell carcinoma (mRCC) who undergo complete metastasectomy have longer survival and delayed initiation of targeted therapy compared with patients not receiving metastasectomy, according to findings from a real-world study.
Investigators compared 229 patients who underwent complete metastasectomy with 803 patients who did not have the procedure matched by propensity score within a cohort of patients in whom metastases developed after nephrectomy. They identified patients using the Canadia Kidney Cancer information system database. All were diagnosed from 2011 to 2019.
Overall survival was 96.0% vs 89.8% at 12 months and 63.2% vs 51.4% at 5 years in the complete metastasectomy and no metastasectomy group, respectively, Alice Dragomir, MSc, PhD, of McGill University in Montreal, Québec, Canada, and colleagues reported in Urologic Oncology. After multivariate analysis, patients who underwent complete metastasectomy had a significant 59% lower risk for mortality than patients without metastasectomy (P <.0001). Median overall survival was 81 vs 61 months, respectively (P =.0001).
Individuals who experienced a first metastasis more than a year after RCC diagnosis had a significant 71% lower risk for mortality with complete metastasectomy (P =.0014). In contrast, patients with metastases in more than 1 organ had triple the risk for mortality than those with only 1 metastatic site (P =.0055). In the overall cohort, 12.0% of the complete metastasectomy group vs 31.6% of the nometastasectomy group had 2 or more metastatic sites. Complete metastasectomy was most commonly performed for lung metastasis (29.4%), likely due to its favorable prognosis, according to the investigators.
Other results showed that first-line targeted therapy was delayed by almost 1 year for patients with vs without complete metastasectomy: 49 vs 38 months, respectively (P =.0057). Sunitinib (17.0% vs 17.8%) and pazopanib (72.6% vs 70%) were the most common therapies in both groups, respectively.
“These findings should support aggressive resection of metastasis in selected patients,” Dr Dragomir’s team concluded.
The researchers could not account for the number and sizes of metastases — factors that may have influenced survival.
Dragomir A, Nazha S, Wood LA, et al. Outcomes of complete metastasectomy in metastatic renal cell carcinoma patients: the Canadian kidney cancer information system experience. Urol Oncol. Published online August 7, 2020. doi:10.1016/j.urolonc.2020.07.021