Impact of metastasectomy on cancer specific and overall survival in metastatic renal cell carcinoma: analysis of the REMARCC Registry
Background - Treatment paradigms for management of metastatic renal cell carcinoma (mRCC) are evolving. We examined impact of surgical metastasectomy on survival across in mRCC stratified by risk-group. - Methods - Multicenter retrospective analysis from the Registry of Metastatic RCC database. The...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
August 2022
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| In: |
Clinical genitourinary cancer
Year: 2022, Volume: 20, Issue: 4, Pages: 326-333 |
| ISSN: | 1938-0682 |
| DOI: | 10.1016/j.clgc.2022.03.013 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.clgc.2022.03.013 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S1558767322000763 
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| Author Notes: | Margaret F. Meagher, Maria C Mir, Riccardo Autorino, Andrea Minervini, Maximilian Kriegmair, Tobias Maurer, Francesco Porpiglia, Siska Van Bruwaene, Estefania Linares, Vital Hevia, Mireia Musquera, Eduard Roussel, Nicola Pavan, Alessandro Antonelli, Shudong Zhang, Fady Ghali, Devin Patel, Juan Javier-Desloges, Aaron Bradshaw, Jose Rubio, Georgi Guruli, Andrew Tracey, Riccardo Campi, Maarten Albersen, Maria Furlan, Rana R. McKay, Ithaar H. Derweesh |
| Summary: | Background - Treatment paradigms for management of metastatic renal cell carcinoma (mRCC) are evolving. We examined impact of surgical metastasectomy on survival across in mRCC stratified by risk-group. - Methods - Multicenter retrospective analysis from the Registry of Metastatic RCC database. The cohort was subdivided utilizing Motzer criteria (favorable-, intermediate-, high-risk). Primary outcome was all-cause mortality (ACM)/overall survival (OS); secondary outcome was cancer-specific mortality (CSM)/cancer-specific survival (CSS). Impact of metastasectomy was analyzed via Cox-Regression analysis adjusting for potential prognostic variables and Kaplan-Meier analysis (KMA) within each risk-group. - Results - Four hundred thirty-one patients (59 favorable-risk, 274 intermediate-risk, 98 high-risk; median follow-up 27.2 months) were analyzed. Metastasectomy was performed in 22 (37%), 66 (24%), and 32 (16%) of favorable-, intermediate- and high-risk groups (P = .012). Median number of metastases at diagnosis differed significantly (favorable-risk 2, intermediate-risk 3.4, high-risk 5.1, P < .001). On Cox-regression, high-risk (HR = 1.72, P = .002) was associated with worsened ACM, while metastasectomy was associated with improved ACM (HR = 0.56, P = .005). On KMA, median OS (months) was longer with metastasectomy in favorable- (92.7 vs. 25.8, P = .003) and intermediate-risk (26.3 vs. 20.1, P = .038), but not high-risk (P = .911) groups. Metastasectomy was associated with longer CSS in favorable- (76.1 vs. 32.8, P = .004) but not intermediate- (P = .06) and high-risk (P = .595) groups. - Conclusions - Metastasectomy was independently associated with improved ACM and CSM, as well as improved CSS and OS in favorable- and intermediate-risk mRCC patients. Metastasectomy may be considered as component of multimodal management strategy in favorable and intermediate-risk subgroups. In high-risk patients, metastasectomy should be deferred except in select circumstances. |
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| Item Description: | Online verfügbar: 9 April 2022, Artikelversion: 21 July 2022 Gesehen am 24.10.2023 |
| Physical Description: | Online Resource |
| ISSN: | 1938-0682 |
| DOI: | 10.1016/j.clgc.2022.03.013 |