Metastasectomy Found to Prolong Survival in Selected mRCC Cases

SAN FRANCISCO—Metastasectomy is associated with increased survival in patients with intermediate- or high-risk metastatic renal cell carcinoma (mRCC), according to new data presented at the 2020 Genitourinary Cancers Symposium.

In patients with intermediate-risk mRCC, the procedure also is associated with improved progression-free survival.

Among 438 patients in the REgistry of MetAstatic RCC (REMARCC) database, 39% (18 of 46) of low-risk, 24% (63 of 262) of intermediate-risk, and 23% (32 of 140) of high-risk patients according to Motzer criteria underwent metastasectomy. A total of 180 patients (41%) had oligometastatic disease.

Metastasectomy was associated with significantly longer median progression-free survival (PFS) in intermediate-risk patients (24.0 vs 6.7 months) but not in high- or low-risk patients, Margaret Frances Meagher, BA, of the University of California San Diego, reported. Metastasectomy also was associated with significantly longer median overall (OS) in intermediate-risk patients (56.9 vs 29.3 months) and high-risk patients (18.2 vs 10.5 months) patients, but not in low-risk patients. The sample size may have been too small to show a benefit in low-risk patients, Meagher told Renal & Urology News. The team is conducting a follow-up analysis to verify or refute these initial findings.

Multivariate analyses revealed that older age, higher body mass index, and higher risk category significantly and independently predicted worse PFS and OS.

Compared with patients with low-risk disease, those with intermediate- and high-risk risk disease had 7.4- and 3.4-fold greater odds of disease progression, respectively, and 2.8- and 2.3-fold greater odds of death, the investigators reported.

As expected, low-, intermediate-, and high-risk patients differed significantly in Eastern Cooperative Oncology Group (ECOG) performance status, hemoglobin levels, lactic acid dehydrogenase (LDH), and metastases at diagnosis (as risk category increased from low to intermediate to high, the odds of metastases increased by 1.7-, 3.5, and 6.5-fold, respectively).

“The role of metastasectomy has been in flux as treatment paradigms for management of metastatic renal cell carcinoma have shifted,” Meagher said. “These study findings challenge prevailing assumptions about the utility of metastasectomy.

“Metastasectomy should be part of multimodal treatment including systemic therapies for mRCC, especially in the intermediate-risk group. Patient selection is critical and should take into account other important risk factors such as performance status, baseline hemoglobin and LDH levels, as well as surgical risks due to the location of metastasis. Further investigation is requisite to refine criteria.”

In the study, 29.2% of patients experienced a complication within the first 30 days of surgery, which compares well with published reports of complications for radical and partial nephrectomy in the setting of localized disease, according to Meagher.

Reference

Meagher MF, Autorino R, Kriegmair M, et al. Impact of metastasectomy on progression free and overall survival in metastatic renal cell carcinoma: Analysis of the REMARCC registry. Presented at the 2020 Genitourinary Cancers Symposium held February 13 to 15 in San Francisco. Poster and abstract 753.

This article originally appeared on Renal and Urology News