The Role of Cytoreductive Nephrectomy in Contemporary Metastatic Renal Cell Carcinoma: An Other-Cause Mortality Match Population-Based Study.

OBJECTIVE

A post-hoc analysis of CARMENA trial revealed that cytoreductive nephrectomy (CN) might still be beneficial for selected metastatic renal cell carcinoma (mRCC) patients. However, selection bias influences the choice of patients for CN, typically favoring those in better health and with a lower risk of all-cause mortality. We aimed to evaluate the impact of CN on cancer-specific mortality (CSM), using a cohort of mRCC patients matched for other-cause mortality (OCM).

METHODS

The SEER database was queried to identify patients diagnosed with mRCC and treated with immunotherapy between 2010 and 2017. A Cox regression model calculating OCM was used to create a propensity score match cohort. Cumulative incidence curves depicted, and competing risks multivariable regression tested, the impact of CN versus no-surgery on CSM according to number of metastasis sites.

RESULTS

Our match yielded to 1148 patients equally distributed between CN and no-surgery arm, with no difference in OCM (HR: 0.88, 95% CI: 0.53-1.47, P = .6). When stratifying patients for number of metastases sites, nonsurgery arm was associated with higher CSM rates for patients with 1 (HR: 1.93, 95% CI: 1.54-2.41, P < .001) or 2 sites (HR: 1.54, 95% CI: 1.27-1.86, P < .001). Conversely, no difference in CSM were observed for 3 or more sites (HR: 1.35, 95% CI: 0.93-1.97, P = .1).

CONCLUSIONS

In a matched cohort of mRCC patients treated with immunotherapy and comparable OCM risk, CN provided a CSM advantage for patients with up to 2 metastatic sites. This advantage was not observed in case of 3 or more sites.